Abstract
BackgroundVertebral artery origin (VAO) stenosis is occasionally observed in patients who have acute ischemic stroke. We investigated the long-term outcomes and clinical significance of VAO stenosis in patients with acute ischemic stroke.MethodsWe performed a prospective observational study using a single stroke center registry to investigate the risk of recurrent stroke and vascular outcomes in patients with acute ischemic stroke and VAO stenosis. To relate the clinical significance of VAO stenosis to the vascular territory of the index stroke, patients were classified into an asymptomatic VAO stenosis group and a symptomatic VAO stenosis group.ResultsOf the 774 patients who had acute ischemic stroke, 149 (19.3%) of them had more than 50% stenosis of the VAO. During 309 patient-years of follow-up (mean, 2.3 years), there were 7 ischemic strokes, 6 hemorrhagic strokes, and 2 unknown strokes. The annual event rates were 0.97% for posterior circulation ischemic stroke, 4.86% for all stroke, and 6.80% for the composite cardiovascular outcome. The annual event rate for ischemic stroke in the posterior circulation was significantly higher in patients who had symptomatic VAO stenosis than in patients who had asymptomatic stenosis (1.88% vs. 0%, p = 0.046). In a multivariate analysis, the hazard ratio, per one point increase of the Essen Stroke Risk Score (ESRS) for the composite cardiovascular outcome, was 1.46 (95% CI, 1.02-2.08, p = 0.036).ConclusionsLong-term outcomes of more than 50% stenosis of the VAO in patients with acute ischemic stroke were generally favorable. Additionally, ESRS was a predictor for the composite cardiovascular outcome. Asymptomatic VAO stenosis may not be a specific risk factor for recurrent ischemic stroke in the posterior circulation. However, VAO stenosis may require more clinical attention as a potential source of recurrent stroke when VAO stenosis is observed in patients who have concurrent ischemic stroke in the posterior circulation.
Highlights
Vertebral artery origin (VAO) stenosis is occasionally observed in patients who have acute ischemic stroke
Among the 774 patients who were eligible for the CEMRA analysis of VAO, 149 (19.3%) had more than 50% stenosis of VAO
When comparing the asymptomatic and symptomatic VAO stenosis groups, concurrent vertebrobasilar stenosis was more prevalent in patients with symptomatic VAO stenosis (21.9% in the asymptomatic group vs. 38.4% in the symptomatic group, p = 0.037) (Table 1)
Summary
Vertebral artery origin (VAO) stenosis is occasionally observed in patients who have acute ischemic stroke. We investigated the long-term outcomes and clinical significance of VAO stenosis in patients with acute ischemic stroke. Atherosclerosis of the vertebrobasilar artery is one of the major causes of ischemic stroke in the posterior circulation [2,3]. A recent pooled analysis study indicated that symptomatic vertebrobasilar stenosis can be a strong predictor of stroke recurrence [12]. Our study was performed to investigate the long-term outcomes in patients who had acute ischemic stroke and VAO stenosis and to examine the clinical significance of VAO stenosis as a potential risk factor for ischemic stroke in the posterior circulation or other cardiovascular outcomes
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