E5266. Percutaneous Transluminal Angioplasty and Stenting in Patients With Symptomatic Intracranial Vertebrobasilar Artery Stenosis
  1. Ramtin Pourahmad; Tehran University of Medical Sciences, Faculty of Medicine
  2. Hamed Ghorani; Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Science
  3. Kiarash Saleki; Babol University of Medical Sciences
  4. Sina Zoghi; Shiraz University of Medical Sciences
  5. Ramtin Hajibeygi; Abadan University of Medical Sciences
  6. Ravi Shastri; Baylor College of Medicine
  7. Mohammad Ghasemi Rad; Baylor College of Medicine
The posterior circulation accounts for around 20% of all ischemic strokes, meanwhile vertebrobasilar stenosis is responsible for about 25% of them and contributes to a high risk of stroke recurrence worldwide. Studies showed that about a quarter of these patients have atherosclerotic stenosis of at least 50% of the vertebrobasilar artery, which has been shown to be associated with an increased risk of 90-day recurrent vertebrobasilar stroke, particularly in the first few weeks, which is significantly higher when compared to the patients with stenosis of the anterior circulation. We systematically reviewed the literature on percutaneous transluminal angioplasty and/or stenting (PTAS) for VBAS.

Materials and Methods:
PubMed, EMBASE, Web of Science, and Scopus were searched according to PRISMA guidelines to include prospective and retrospective cohorts, randomized and nonrandomized clinical trials, and case series describing PTAS for VBA stenosis. Pooled rates of intervention-related complications and outcomes were analyzed with a random-effect model meta-analysis using StataMP 18.0 software. Aspirin, clopidogrel, and abciximab were the drugs of choice for antiplatelet therapy in patients included in our study.

A total of 37 studies were found eligible, which included 2271 cases. Of those cases, 1424 basilar artery stenosis cases were reported in 33 studies (0.69, 95% CI 0.60–0.79), p = 0.00, 735 vertebrobasilar cases were reported in 21 studies (0.55, 95% CI 0.45–0.64), p = 0.00, and five studies reported 29 cases with vertebrobasilar stenosis (0.14, 95% CI 0.06–0.22), p = 0.06. Comorbidities reported in the included studies were hypertension, diabetes, coronary artery disease, and dyslipidemia. Mean stenosis at baseline was 82.91% (95% CI 79.14–86.68), I2 = 0.00, p = 1.00, which shows that variation of baseline stenosis between studies was minimal. Mortality was reported in 29 studies. Meta-analysis of mortality showed overall mortality was 0.03 (95% CI 0.02–0.04), p = 0.01. In 17 studies, 13 sICH events were recorded at an overall rate of 0.01 (95% CI 0.00–0.01), p = 0.95. Generally, a follow-up period of at least 3 months was reported. Furthermore, 24 studies reported 109 TIA or stroke events in their follow-up period 0.07 (95% CI (0.05–0.09), I2 = 46.33%, p = 0.02. Restenosis over 50% was reported in 26 studies in 115 cases (0.07, 95% CI 0.05–0.09), I2 = 60.24%, p = 0.02. Meta-regression analysis for sample size as a predictor could not identify a source for heterogeneity. Mean time from initial symptoms to recanalization was 23.98 (95% CI 18.56–29.40), I2 = 98.8%), p = 0.00.

In certain individuals with medically unresolved, severe, symptomatic, and nonacute VBA stenosis, elective vertebrobasilar PTAS appears to be both safe and effective. Various stent designs and angioplasty-assisted techniques should be taken into consideration based on the specific clinical and radiological traits of the lesions. Future randomized controlled trials are required to verify these results.