Stenting for symptomatic vertebral artery stenosis: a preplanned pooled individual patient data analysis
| Autor: | Anil Gholkhar, Annette Compter, Ahamad Hassan, Marcus Bradley, Sanjeev Nayak, Pankaj Sharma, Ian Ford, Ralf-Bjoern Lindert, Bartlomiej Piechowski-Jozwiak, Alakendu Sekhar, Maneesh Patel, Barry Moynihan, Wilhelm Küker, Frans L. Moll, Susanna C. Larsson, Willem P.Th.M. Mali, L. Jaap Kappelle, Hans Nahser, T Hauw Lo, Eric L. Harshfield, Hugh S. Markus, Senthil Raghunathan, N Higgins, Anthony Goddard, Anand Dixit, Wouter J. Schonewille, Peter Gaines, S Wuppalapati, Jeremy Madigan, Timothy Hampton, Hedley C. A. Emsley, David J. Werring, Christine Roffe, Peter M. Rothwell, H. Bart van der Worp, Ale Algra, Andrew Clifton, Stefan Brew, Robert Crossley, Ursula G. Schulz, Jan Albert Vos, Neil Baldwin |
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| Přispěvatelé: | Markus, Hugh [0000-0002-9794-5996], Harshfield, Eric [0000-0001-8767-0928], Apollo - University of Cambridge Repository |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Clinical Neurology 030204 cardiovascular system & hematology Vertebral artery stenosis law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Risk Factors law Vertebrobasilar Insufficiency medicine Humans Vertebrobasilar insufficiency Stroke Aged business.industry Hazard ratio Patient data Middle Aged medicine.disease Stenosis Stroke prevention Female Stents Neurology (clinical) Radiology business 030217 neurology & neurosurgery |
| Zdroj: | Lancet Neurology, 18(7), 666. Lancet Publishing Group |
| ISSN: | 1474-4422 |
| Popis: | Background Symptomatic vertebral artery stenosis is associated with a high risk of recurrent stroke, with higher risks for intracranial than for extracranial stenosis. Vertebral artery stenosis can be treated with stenting with good technical results, but whether it results in improved clinical outcome is uncertain. We aimed to compare vertebral stenting with medical treatment for symptomatic vertebral stenosis. Methods We did a preplanned pooled individual patient data analysis of three completed randomised controlled trials comparing stenting with medical treatment in patients with symptomatic vertebral stenosis. The primary outcome was any fatal or non-fatal stroke. Analyses were performed for vertebral stenosis at any location and separately for extracranial and intracranial stenoses. Data from the intention-to-treat analysis were used for all studies. We estimated hazard ratios (HRs) with 95% CIs using Cox proportional-hazards regression models stratified by trial. Findings Data were from 354 individuals from three trials, including 179 patients from VIST (148 with extracranial stenosis and 31 with intracranial stenosis), 115 patients from VAST (96 with extracranial stenosis and 19 with intracranial stenosis), and 60 patients with intracranial stenosis from SAMMPRIS (no patients had extracranial stenosis). Across all trials, 168 participants (46 with intracranial stenosis and 122 with extracranial stenosis) were randomly assigned to medical treatment and 186 to stenting (64 with intracranial stenosis and 122 with extracranial stenosis). In the stenting group, the frequency of periprocedural stroke or death was higher for intracranial stenosis than for extracranial stenosis (ten (16%) of 64 patientsvsone (1%) of 121 patients; pinteraction=0·395). Interpretation Stenting for vertebral stenosis has a much higher risk for intracranial, compared with extracranial, stenosis. This pooled analysis did not show evidence of a benefit for stroke prevention for either treatment. There was no evidence of benefit of stenting for intracranial stenosis. Stenting for extracranial stenosis might be beneficial, but further larger trials are required to determine the treatment effect in this subgroup. Funding None. |
| Databáze: | OpenAIRE |
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