MedWire News: Endovascular stenting is a relatively low-risk treatment option for patients with symptomatic vertebral artery stenosis, report US researchers.
About a third of patients with symptomatic vertebral artery stenosis will suffer a stroke over a 5-year period, and about 30% of those who do will die within 2 years, say J Stephen Jenkins and team from Ochsner Clinic Foundation in New Orleans, Louisiana.
They say that surgery to correct vertebral artery stenosis is possible but that “the combined morbidity and mortality rates of vertebral artery stenosis surgical therapy range from 10% to 20% and have dampened enthusiasm for this option.”
But endovascular stenting – by an experienced operator – may be a relatively low-risk and effective treatment option, the team reports in the Journal of the American College of Cardiology.
Between 1995 and 2006, Jenkins and colleagues treated 105 patients with symptomatic vertebral artery stenosis. The stenosis was extracranial in 91% of patients and intracranial in 9%. Concomitant carotid stenosis was present in 68% of patients, 54% had bilateral vertebral artery stenosis, and 41% had already suffered a stroke.
Stents were successfully placed in all patients, leaving residual stenosis of 30% or less and causing no peri-operative deaths or strokes. Symptoms resolved completely in 90.4% of patients.
Of the 87 patients who were followed-up 1 year later, 79.3% remained symptom-free, 5.7% had died, 5.0% had suffered a posterior circulation stroke, and 7.4% needed revascularization. After a median of 29 months, 71.4% were alive, 70.5% remained symptom-free, and 13.1% had required revascularization.
Jenkins et al say that treatment of vertebral artery stenosis has advanced rather slowly, due in part to a nonpayment decision by Medicare in 1984.
They say this “is difficult to understand in view of the positive track record for percutaneous transluminal angioplasty and stenting in other vascular territories and the lack of treatment alternatives for a disease with a 2-year mortality for medically treated vertebrobasilar system disease of 30% and a combined surgical morbidity/mortality of 25%.”
The team concludes: “It seems appropriate that this nonpayment decision be revisited.”
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