Risk of Recurrent Ischemic Events in Patients with Symptomatic Vertebro-Basilar Stenosis
Background and Purpose:The long-term outcome in patients with symptomatic vertebro-basilar stenosis is not well defined. We performed this study to determine the long-term risk of stroke or death in a large series of patients with vertebro-basilar stenosis. Methods:We identified patients admitted between January 1995 and December 1997 with ischemic stroke or transient ischemic attack related to stenosis in either the vertebral or basilar artery at 4 university hospitals. The stenosis was identified either by magnetic resonance angiography or conventional angiography. New ischemic events or death was identified during the follow-up period through clinic visits or telephone interviews. Results:A total of 77 patients (mean age 62.4 ±13.1 years; 43 were men) were identified with stenosis of either vertebral artery (n=28), basilar artery (n=26) or both (n=22). Of the 77 patients, 18 presented with transient ischemic attack and 59 with ischemic stroke. Eight patients died during hospitalization. Of the surviving 69 patients, 24 patients were treated with aspirin, 8 with ticlopidine or clopidogrel, 36 with warfarin and one patient received no treatment. The patients were followed for 47.4 ±35.8 months after the initial event. A total of 14 recurrent ischemic events were observed. The first year risk of new ischemic events for vertebro-basilar stenosis was 9%. The first year rate of ischemic events was similar between antiplatelet agents (9%) and warfarin (8%). Conclusions:A high rate of recurrent ischemic events was observed in patients with vertebro-basilar stenosis despite treatment with antiplatelet agents or anticoagulants.