Related Experiment Videos
Vertebral artery stenosis: long-term follow-up
Insights
Vertebral artery stenosis, often at the origin, is linked to a higher stroke risk and reduced survival. However, brainstem strokes are uncommon, with most deaths being cardiac-related.
Area of Science:
- Neurology
- Vascular Surgery
- Cardiology
Background:
- Vertebral artery (VA) stenosis is a significant risk factor for cerebrovascular events.
- Understanding the natural history and outcomes of VA stenosis is crucial for patient management.
Purpose of the Study:
- To investigate the clinical outcomes, stroke incidence, and survival rates in patients with unilateral vertebral artery stenosis (VAS).
- To determine the common locations of VAS and its association with stroke, particularly brainstem infarction.
Main Methods:
- Prospective follow-up of 96 patients with >=50% unilateral VA stenosis for an average of 4.6 years.
- Analysis of stroke occurrence, cause of death, and survival rates compared to a matched normal population.
- Assessment of VA stenosis location and association with concomitant internal carotid artery stenosis.
Main Results:
- 93% of patients had VA stenosis at the origin; 3% had intracranial VA stenosis.
- 24% of patients experienced strokes, with an observed stroke rate 8.5 times higher than the expected rate.
- The 5-year survival rate was 60%, significantly lower than the 87% in a matched normal population; cardiac causes were the most frequent cause of death.
Conclusions:
- Unilateral VA stenosis is frequently located at the origin and is associated with increased stroke risk and reduced long-term survival.
- Despite the high stroke rate, brainstem infarction is rare, with only two fatal cases linked to basilar artery stenosis.
- Cardiac disease is a major contributor to mortality in patients with VA stenosis.
Abstract:
Ninety-six patients with greater than or equal to 50% unilateral vertebral artery (VA) stenosis were followed up for an average of 4.6 years. In 89 patients (93%) at least one VA origin was involved, while the intracranial VA was affected in 3 patients (3%). Seventy-four patients (77%) had greater than or equal to 50% stenosis of at least one internal carotid artery, of whom 52 underwent carotid endarterectomy. None of the patients had definite vertebrobasilar transient ischemic attacks (VB TIA). Nineteen patients (19.8%) experienced non-localizing symptoms possibly compatible with VB TIA, none of whom had a stroke. Twenty-three patients (24%) had strokes. The only two patients (2%) who sustained a brainstem infarction had fatal strokes and both were known to have basilar artery stenosis in addition to their VA stenosis. The observed stroke rate was 8.5 times the expected infarction rate for a normal population. Forty patients died during follow up. The observed 5-year survival rate was 60% compared to 87% in a matched normal population. Eight deaths (20% of all deaths) were caused by stroke and 21 deaths (52.5% of all deaths) were cardiac related. VA stenosis is most frequently located at the VA origin (93%), and is associated with a low incidence of brainstem infarction.