Stroke-free survival and its determinants in patients with symptomatic vertebrobasilar stenosis: A multicenter study

Adnan I. Qureshi, M. Fareed K Suri, Wendy C. Ziai, Abutaher M. Yahia, Yousef Mohammad, Souvik Sen, Pinky Agarwal, Osama O. Zaidat, Jose I. Suarez, Robert J. Wityk, Christine A C Wijman, Gary K. Steinberg, Kai U. Frerichs, Robert M. Friedlander, Robert H. Rosenwasser

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125 Scopus citations

Abstract

OBJECTIVE: We sought to determine the long-term stroke-free survival of patients who present with ischemic events related to intracranial vertebrobasilar stenosis. METHODS: A retrospective cohort of patients diagnosed with symptomatic vertebrobasilar stenosis on the basis of magnetic resonance angiography and/or conventional angiography was identified at four academic medical centers. Patients' clinical and follow-up information was obtained through hospitalization records, clinic visits, and telephone interviews. Kaplan-Meier analysis was performed to determine the rate of stroke-free survival for a 5-year period. Cox proportional hazards analysis was performed to determine the effect of demographic and clinical factors on stroke-free survival. RESULTS: A total of 102 patients were included, whose mean age was 64 ± 12 years. Fifty-five (54%) of the patients were men. The mean follow-up period was 15 ± 15.9 months (range, 1-60 mo). During the follow-up period, 14 (14%) of the patients experienced recurrent stroke. The overall mortality rate was 21% (n = 21). Stroke-free survival, calculated by using the Kaplan-Meier curve, was 76% at 12 months (95% confidence interval [CI], 66-83%) and 48% at 5 years (95% CI, 27-65%). The risk of recurrent stroke was 10.9 per 100 patient-years, and the rate of recurrent stroke and/or death was 24.2 per 100 patient-years. Cox proportional hazards analysis revealed that increasing age (hazards ratio, 1.05; 95% CI, 1.00-1.09) decreased stroke-free survival. Treatment with either antiplatelet agents or warfarin (hazards ratio, 0.018; 95% CI, 0.003-0.11) had a protective effect on stroke-free survival after adjusting for age, sex, race, hypertension, diabetes mellitus, smoking, hyperlipidemia, and lesion location. CONCLUSION: A low rate of stroke-free survival is observed in patients with symptomatic vertebrobasilar stenosis. Further studies are required to evaluate new medical and endovascular treatment options for this group of patients to improve long-term stroke-free survival.

Original languageEnglish (US)
Pages (from-to)1033-1040
Number of pages8
JournalNeurosurgery
Volume52
Issue number5
StatePublished - May 1 2003

Keywords

  • Basilar artery
  • Intracranial stenosis
  • Ischemic stroke
  • Recurrence
  • Survival
  • Transient ischemic attack
  • Vertebral artery

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    Qureshi, A. I., Suri, M. F. K., Ziai, W. C., Yahia, A. M., Mohammad, Y., Sen, S., Agarwal, P., Zaidat, O. O., Suarez, J. I., Wityk, R. J., Wijman, C. A. C., Steinberg, G. K., Frerichs, K. U., Friedlander, R. M., & Rosenwasser, R. H. (2003). Stroke-free survival and its determinants in patients with symptomatic vertebrobasilar stenosis: A multicenter study. Neurosurgery, 52(5), 1033-1040.