Elena Zapata-Arriaza, MD
Markus HS, Harshfield EL, Compter A, Kuker W, Kappelle LJ, Clifton A, et al. Stenting for symptomatic vertebral artery stenosis: a preplanned pooled individual patient data analysis. Lancet Neurol. 2019;18:666-673.
Symptomatic vertebral artery stenosis is related to an increased risk of recurrent ischemic stroke. However, the superiority of endovascular treatment over the medical approach in vertebral stenosis is not supported by solid scientific evidence, so it’s difficult to determine which therapeutic option is better. Markus et al. aimed to define whether vertebral stenting is more effective than medical treatment for symptomatic vertebral stenosis, using individual patient data pooled from trials published up to now.
After reviewing randomized controlled trials comparing stenting vs medical treatment for vertebral stenosis, the authors included the VIST, VAST and SAMMPRIS trials in pooled analysis. Data from the intention-to-treat analysis were used for all studies. Primary outcome was any fatal or non-fatal stroke during follow-up. Secondary outcomes were posterior circulation stroke, any stroke or transient ischaemic attack, stroke or death, and periprocedural stroke or death, which was defined as stroke or death within 30 days of randomisation. Analyses were performed for vertebral stenosis at any location and separately for extracranial and intracranial stenoses.