Vertebral artery stenosis: long-term follow-up

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.