Intracranial Vertebrobasilar Stenosis Research Articles

Association between Cerebrovascular Risk Factors and Collateral Compensation in Chronic Symptomatic Intracranial Vertebrobasilar Stenosis

Introduction: The level of collateral compensation plays a pivotal role in chronic symptomatic intracranial vertebrobasilar stenosis (IVBS). This study aimed to evaluate the association between cerebrovascular risk factors and collateral compensation in chronic symptomatic IVBS. Methods: This single-center cross-sectional study retrospectively reviewed 238 patients with angiographically demonstrated IVBS and divided them into good collateral compensation (GCC) group (collateral grade: 3–4, n = 110) and poor collateral compensation (PCC) group (collateral grade: 0–2, n = 128). The demographic information, laboratory tests, and clinical data of the two groups were compared and assessed using univariate logistic regression. Multivariate logistic regression was employed to analyze the independent related factors of collateral compensation. Results: Hyperlipidemia, high-density lipoprotein (HDL), and fasting blood glucose (FBG) were significantly different between the two groups. Multivariate logistic regression analysis revealed that HDL (odds ratio [OR]: 1.134, 95% confidence interval [CI]: 1.081–1.190), FBG (OR: 0.945, 95% CI: 0.925–0.964), and hyperlipidemia (OR: 0.261, 95% CI: 0.129–0.527) were statistically independent related factors of collateral compensation. The receiver-operating characteristic (ROC) analysis provided cutoff values of 34 mg/dL and 135 mg/dL for HDL and FBG associated with GCC and PCC. Conclusion: Higher HDL levels are associated with higher incidence of GCC, whereas higher FBG levels and hyperlipidemia are associated with higher incidence of PCC.

A Retrospective Study Comparison Between Stenting and Standardized Medical Treatment for Intracranial Vertebrobasilar Stenosis in a Real-World Chinese Cohort.

Background: To date, there has been no consensus regarding the benefits of percutaneous transluminal angioplasty and stenting (PTAS) vs. those of standardized medical treatment (SMT) for patients with symptomatic intracranial vertebrobasilar stenosis (IVBS). The purpose of this retrospective study was to compare the effects of PTAS or SMT on symptomatic IVBS in a real-world Chinese population.Methods: We included 238 patients with ischemic stroke caused by IVBS stenosis who were admitted to Shandong Provincial Hospital Affiliated to Shandong University between September 2012 and May 2018; 62 of these patients were treated with SMT and 176 underwent PTAS. Ischemic stroke in the territory of the responsible artery, hemorrhage, and death within 1 year were recorded as primary endpoints. Secondary endpoints included assessment of stroke severity and the incidence of re-stenosis. The primary endpoint rates were compared between the PTAS and SMT groups at 7 days, 1, 6 months, and 1 year.Results: In the PTAS group, the success rate of stent placement was 98.9%. During the entire trial, except for 7 days, the SMT group had a higher frequency of primary endpoint events than did the PTAS group. The primary endpoint was 17.7% (11/62) vs. 8.6% (15/174) at 1 month (p = 0.049), 29% (18/62) vs. 14.4% (25/174) at 6 months (p = 0.01), and 32.2% (20/62) vs. 17.2% (30/174) at 1 year (p = 0.013). The restenosis rate of the target lesion was 13.8%; 60% were symptomatic restenosis and 40% were asymptomatic restenosis. The rate of severe stroke at 1 year after PTAS was 0%, while that in the SMT group was 9.7%.Conclusions: In a real-world Chinese cohort, PTAS for patients might be superior to SMT, and provide better long-term neurological function recovery and lower disability rate.

Endovascular Treatment of Symptomatic Intracranial Vertebrobasilar Stenosis: A 10-Year Single Centre Experience Using Balloon-Expandable Coronary Artery Stents

Symptomatic intracranial vertebro-basilar stenoses (SIVBS) are associated with high risk of recurrent ischemic stroke, even in patients receiving the best medical treatment. Although medical treatment is still the standard of care, non-responding patients may require endovascular treatment; balloon-mounted coronary stents (BMCS) could be successfully employed. This study aims to retrospectively analyze our high volume Interventional Neurovascular center ten-year experience in the off-label use of BMCS for the treatment of SIVBS, in order to assess its feasibility and safety. We retrospectively analyzed all consecutive patients with SIVBS treated with BMCS in the last ten years in our center. Data collected included patient demographics, stenosis location and characteristics, early (<30 days) and late (>30 days) stroke and death rates, pre-symptomatic and post-treatment modified Rankin Scale (mRS) scores. 42 patients (35 males, average age 65,7±10,7, range 37-85) with SIVBS were treated with BMCS. Thirty-four (80,9%) patients were symptomatic despite ongoing best medical therapy; eight (19,1%) patients were treated in emergency for large vessel occlusion, due to an underlying stenosis. BMCSs were successfully deployed in all cases. The incidence of stroke and death at one month was 7,1% (3/42). The incidence of TIA, stroke and death at long-term follow-up (average time of 3 years) was 14,3% (4,7 per 100 person-years). At long-term follow-up, mRS improved in 82% of patients who underwent elective treatment. In our experience, the off-label use of BMCS in the endovascular treatment of SIVBS resistant to medical treatment is feasible and safe.

A new simple method using carotid duplex ultrasonography to assess intracranial vertebrobasilar arterial stenosis

ObjectivesMagnetic resonance angiography (MRA), three-dimensional computed tomography angiography, and cerebral angiography may be used to assess intracranial vertebrobasilar stenosis. However, these examinations cannot be performed at patients' bedsides. Our purpose was to develop a new bedside method to assess intracranial vertebrobasilar arterial stenosis. MethodsWe developed the new method using carotid duplex ultrasonography combined with the head-up test. A total of 141 subjects admitted between June 1, 2017 and March 31, 2019 were enrolled in this study. We calculated vertebral arterial peak systolic velocities (PSVs), end-diastolic velocities (EDVs), and mean velocities (MVs) at 0°, 16°, and 30° head-up angles. Vertebrobasilar arterial stenosis was confirmed using MRA. ResultsWe excluded 28 subjects and included data for 113 subjects and 226 vessels in the final analysis. Cervical vertebral arterial PSV, EDV, and MV gradually decreased from 0° to 30° only in stenotic intracranial vertebral arteries. Sensitivity (probability of detection) was 75.5% and specificity (true negative rate) was 79.7% when EDV at the 30° head-up angle decreased ≥19.5% from the initial 0° head-up angle. Specificity was better (86.4%; sensitivity: 69.4%) when EDV was <9.1 cm/s at the 30° head-up angle. ConclusionThis new method easily detects intracranial vertebrobasilar arterial stenosis.

Endovascular treatment of patients with high-risk symptomatic intracranial vertebrobasilar stenoses: long - term outcomes

Background and purposeWe present the long-term outcome after endovascular treatment of symptomatic intracranial posterior circulation stenoses.Methods30 patients with symptomatic intracranial posterior circulation stenoses exceeding 70% underwent endovascular treatment between 2006...

Center volume and the outcomes of percutaneous transluminal angioplasty and stenting in patients with symptomatic intracranial vertebrobasilar stenoses: A meta-analysis.

BackgroundEvidence for the preventative effects of percutaneous transluminal angioplasty and stenting (PTAS) on the recurrence of stroke in patients with severe intracranial vertebrobasilar stenoses (IVBS) varies, and the influence of study characteristics on the study outcomes have not been determined.MethodsA study level based meta-analysis was performed to investigate the influence of baseline characteristics on the 30-day and follow-up stroke recurrence or death in symptomatic IVBS patients receiving PTAS. Relevant single center studies were retrieved by searching PubMed and Embase. A random effect model was applied to synthesize the outcomes. Meta-regression and subgroup analyses were performed to evaluate the potential influence of study characteristics on outcomes.ResultsFifteen cohort studies comprising 554 symptomatic IVBS patients were included. PTAS was associated with an 8% incidence of stroke recurrence or death (95% CI: 5% to 12%) in IVBS patients within 30 days, and 8 per 100 person-years (95% CI: 5 to 11 per 100 person-years) of cumulative stroke recurrence or death during follow-up. Meta-regression indicated that the center volume, as defined by the numbers of cases per year, was negatively correlated with 30-day (regression coefficient = -0.09, p = 0.02) and follow-up (regression coefficient = -0.60, p = 0.01) stroke recurrence or death. Age, gender, or comorbidities have no significant effect on the outcomes.ConclusionsCenters of higher procedural volume may be associated with better clinical outcomes for symptomatic IVBS patients receiving PTAS.

Associations between fatty liver index and asymptomatic intracranial vertebrobasilar stenosis in Chinese population

Metabolic diseases such as type 2 diabetes mellitus (T2DM) and metabolic syndromes (MetS) have been recognized as the important risk factors for asymptomatic intracranial vertebrobasilar stenosis (IVBS). Although fatty liver index (FLI) is significantly related with these diseases, the association between FLI and IVBS remains unclear. In the present study, 2368 participants (30–75 years) were recruited from a Chinese prospective cohort study of PMMJS. Amongst them, 2281 individuals who did not have IVBS at baseline were enrolled in the 6-year following-up study. In cross-sectional analysis based on the baseline characteristics, the results showed that FLI was positively related with IVBS prevalence. Compared to the participants with FLI < 30, the adjusted OR (95% CI) of IVBS was 2.07 (1.18, 3.62) and 2.85 (1.39, 5.18) in the groups of 30 ≤ FLI < 60 and FLI ≥ 60, respectively. In longitudinal analysis, the results showed that the participants with FLI ≥ 60 had an increased risk of asymptomatic IVBS compared to those with FLI < 30 [adjusted HR (95%CI): 1.65 (1.05, 2.60)]. Moreover, exclusion of persons with hypertension, T2DM and MetS did not alter the associations between FLI and asymptomatic IVBS. Therefore, our results suggest that elevated FLI is an independent risk factor for asymptomatic IVBS in Chinese adults.

Spanning from the West to East: An Updated Review on Endovascular Treatment of Intracranial Atherosclerotic Disease.

Ischemic stroke is a major cause of morbidity and mortality, incurring significant cost. Intracranial atherosclerotic disease (ICAD) accounts for 10-15% of ischemic stroke in Western societies, but is an underlying pathology in up to 54% of ischemic strokes in Asian populations. ICAD has largely been treated with medical management, although a few studies have examined outcomes following endovascular treatment. Our objective was to summarize the major trials that have been performed thus far in regard to the endovascular treatment of ICAD and to provide direction for future management of this disease process. Systematic review of the literature from 1966 to 2015, was conducted in regard to intracranial angioplasty and stenting. Studies were analyzed from PubMed, American Heart Association and Society of Neurointerventional Surgery databases. SAMMPRIS and VISSIT are the only randomized controlled trials from which Western guidelines of intracranial stenting have been derived, which have displayed the superiority of medical management. However, pooled reviews of smaller studies and other nonrandomized trials have shown better outcomes with endovascular therapy in select patient subsets, such as intracranial vertebrobasilar stenosis or in the presence of robust collaterals. Suboptimal cases, including longer lesions, bifurcations and significant tortuosity tend to fair better with medical management. Medical management has been shown to be more efficacious with less adverse outcomes than endovascular therapy. However, the majority of studies on endovascular management included a diverse patient population without ideal selection criteria, resulting in higher adverse outcomes. Population analyses and selective utilization of endovascular therapy have shown that the treatment may be superior to other management in select patients.

Single Centre Experience of Endovascular Intervention in Extra and Intracranial Vertebro-Basilar Stenosis at a Tertiary Care Centre (P1.197)

Single Centre Experience of Endovascular Intervention in Extra and Intracranial Vertebro-Basilar Stenosis at a Tertiary Care Centre (P1.197)

Stenting Versus Aggressive Medical Management for Symptomatic Vertebral Artery Stenosis

Posterior circulation strokes account for 20% of all strokes (2). Traditional studies cite a 5-year stroke rate ranging from 22%e 35% following an initial vertebrobasilar transient ischemic attack (TIA) or stroke (11, 14). Contrary to traditional beliefs, the overall risk of recurrent stroke in the posterior circulation is similar to the risk after an anterior circulation stroke, and likely higher in the acute phase (8). In one pooled analysis of 359 patients experiencing vertebrobasilar territory TIA or stroke, the 90-day risk of stroke after the presenting event was 9.6% in patients with vertebrobasilar stenosis versus 2.8% in those without (OR 3.7, 95% CI 1.2e11.0, P 1⁄4 0.012) (9). The authors noted a trend that this risk was higher with intracranial vertebrobasilar stenosis than extracranial vertebral stenosis (P 1⁄4 0.06). To mitigate this risk, aggressive medical management incorporating diet and lifestyle modification, control of hypertension, and the usage of statins and antiplatelet agents may be used (3, 5, 16). In addition, multiple individual case series have suggested that stenting vertebrobasilar lesions may be associated with a low-risk profile and subsequently low rates of referable TIAs or strokes (1, 10, 12, 13, 15). A systematic review of stenting symptomatic, atherosclerotic vertebrobasilar disease reported periprocedural TIA, stroke, and death rates of 1.6%, 1.3%, and 0.3%, respectively, across 313 cases with proximal vertebral artery disease (6). Over a mean follow-up period of 14.2 months, the post-treatment annual rate of TIA or stroke in the vertebrobasilar territory was 0.6%. Interestingly, for 283 cases of distal vertebrobasilar stenting, the periprocedural TIA, stroke, and death rates were 0.7%, 10.6% and 3.2%, respectively (6). The annual rate of subsequent vertebrobasilar stroke over a mean follow-up of 13 months after treatment was 1.9%. Thus although patients with symptomatic intracranial vertebrobasilar stenosis may have a greater risk of TIA or stroke without treatment (9), the risk of stenting may also be higher in this group (6). However, more specifically, a subgroup analysis from the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial demonstrated significantly higher periprocedural ischemic events in patients undergoing stenting of the basilar artery as compared with those undergoing stenting of the intracranial internal carotid, middle cerebral, or vertebral artery (7). Before the Vertebral Artery Stenting Trial (VAST) (3), subgroup analyses of 2 randomized control trials comparing stenting of symptomatic arterial stenosis to best medical management demonstrated no benefit of stenting for patients with vertebral artery stenosis (4, 5). In the Carotid And Vertebral Artery Transluminal Angioplasty Study (CAVATAS), 16 patients with

Combined Use of Mechanical Thrombectomy with Angioplasty and Stenting for Acute Basilar Occlusions with Underlying Severe Intracranial Vertebrobasilar Stenosis: Preliminary Experience from a Single Chinese Center.

Acute basilar occlusions have a poor prognosis without recanalization. Many have underlying severe atherosclerotic intracranial stenosis coexisting with acute thrombosis, requiring treatment of both pathologies in the same session, though technical risks may be encountered. The purpose of this study was to evaluate the technical feasibility and safety of combined treatment by using stent retrievers for the thrombosis, together with angioplasty and stent placement for the underlying stenosis. This was a retrospective review of 13 patients with basilar occlusions treated with thrombectomy by the Solitaire stent retriever and angioplasty and intracranial stent placement for underlying severe vertebrobasilar stenosis in the same session. Reperfusion was assessed in terms of the TICI score. Perioperative complications were recorded. Clinical outcomes were assessed by the NIHSS at discharge and the mRS on follow-up at 90 days. Of the 30 patients with acute basilar artery occlusions treated with stent retrievers during the study period, 18 had coexisting severe intracranial stenosis. Thirteen patients meeting the criteria for our study received combined mechanical thrombectomy and angioplasty with stent placement. The successful recanalization rate was 100%. Distal vessel embolizations occurred in 3 patients. There were 2 mortalities. On discharge, 10 patients (77%) had an improvement in NIHSS of ≥10 points. At 90 days, 6 patients (46%) had a good functional outcome with an mRS of ≤2. The combined use of mechanical thrombectomy with angioplasty and stent placement for acute basilar occlusions with underlying severe intracranial atherosclerotic stenosis is technically feasible and safe.

Selective use of transradial access for endovascular treatment of severe intracranial vertebrobasilar artery stenosis

ObjectiveTo study the feasibility and safety of transradial artery access for endovascular intervention of severe intracranial vertebrobasilar stenosis for selected patients not suitable for transfemoral access. MethodsThis was a retrospective analysis of 58 patients who had undergone intervention for severe intracranial vertebrobasilar stenosis using transradial access between January 2012 and September 2014. The reasons for transradial access were traced. The outcome measures were the technical success rate, 30-day stroke or death in the territory of the culprit artery, periprocedural and access site complication rates. ResultsOut of the 58 patients, 19 patients (32.8%) used the transradial approach due to poor iliofemoral artery access, 28 (48.3%) due to unfavorable brachiocephalic or subclavian artery anatomy, 11 (19%) due to unfavorable vertebral artery anatomy. The technical success rate was 100%. There were four periprocedural complications, one of which was asymptomatic. The 30-day stroke rate was 5.2% (3/58 patients), with two of them having no residual neurological deficits. There was no mortality. None had access site complications. ConclusionsFor selected patients with severe intracranial vertebrobasilar stenosis with difficult femoral access or anatomical variations precluding provision of a stable support for intracranial intervention, the transradial approach was shown to be a safe and feasible alternative route of access. Future trials of endovascular treatment for intracranial posterior circulation strokes should take into account the route of access.

Stroke recurrence rates among patients with symptomatic intracranial vertebrobasilar stenoses: systematic review and meta-analysis

BackgroundA recent randomized trial of patients with primarily anterior circulation intracranial artery stenosis showed that intensive medical therapy was superior to intracranial stenting in preventing recurrent stroke. The rate of...

Régression de sténoses intracrâniennes vertébrobasilaires symptomatiques sous corticothérapie au cours d’une maladie de Horton

Involvement of intracranial arteries in giant cell arteritis is a rare condition but often carries a fatal prognosis. Corticosteroids seem to be insufficient to avoid ischemic cerebral complications, and could even promote the occurrence of stroke. We report the case of a patient with giant cell arteritis who experienced recurrent cerebellar stroke caused by intracranial vertebrobasilar stenoses with a favorable outcome following treatment. A 77-year-old woman presented with a 3-month history of impaired general condition. She had new-onset headaches, jaw claudication and transient vertigo, especially when she woke-up. The brain MRI showed a recent cerebellar infarction. One week later, she was hospitalized for a clinical deterioration related to a recurrent cerebellar stroke caused by intracranial vertebro-basilar stenoses. Giant cell arteritis was confirmed on the temporal artery biopsy. A treatment with high-dose oral corticosteroids was begun associated with an intensive antiplatelet therapy. The clinical outcome was favorable with rapid improvement of gait imbalance together with a complete radiological regression of the intracranial stenoses. Ischemic stroke in giant cell intracranial arteritis is a severe condition without a well-defined treatment. Corticosteroid therapy improves intracranial stenoses caused by vasculitis but should be initially associated with an intensive antithrombotic therapy to avoid early recurrence of cerebral infarcts.

Ultrasonic diagnosis of the vertebrobasilar system. II. Transnuchal diagnosis of intracranial vertebrobasilar stenoses using a novel pulsed Doppler system

This report deals with the non-invasive detection of haemodynamically non-significant stenoses of the intracranial part of the vertebrobasilar system. A new Doppler device transmitting pulsed 2 MHz ultrasound was used. Among 67 patients with transient or stable neurological deficits of the posterior circulation area, five were found to have stenoses of the distal vertebral artery or basilar artery, respectively. Transnuchal approach via the foramen magnum was used. The findings were confirmed by angiography. Twelve subjects with normal Doppler findings also underwent angiography. Three of them presented irregularities and plaquing of the vertebrobasilar trunk without circumscribed stenosing lesions. Transcranial pulsed Doppler sonography permits non-invasive detection of intracranially located stenoses of the vertebrobasilar system which, up to now, could not be diagnosed with the help of extracranial conventional continuous-wave Doppler alone. This new method allows early detection of basilar artery occlusive disease. The effectiveness of anticoagulation and fibrinolysis can be assessed non-invasively.

Long-term outcome of elective stenting for symptomatic intracranial vertebrobasilar stenosis

Seventy-nine consecutive patients with symptomatic atherosclerotic stenosis > or = 50% of intracranial vertebrobasilar artery (VBA) were treated by elective stenting. There were five strokes within 30 days, and three strokes in the VBA territory after 30 days (mean of 812 days). The annual stroke rate in the VBA territory (including any stroke and death within 30 days) was 4.6%. At the last follow-up time, 73 patients were independent (modified Rankin scale grade < or = 2). The outcome compares favorably with medical therapy.

頭蓋内椎骨脳底動脈系動脈硬化性狭窄病変に対するａｎｇｉｏｐｌａｓｔｙおよびｓｔｅｎｔｉｎｇの臨床成績

Recently, angioplasty/stenting has been reported as a treatment option for intracranial atherosclerotic stenosis. We describe clinical results of angioplasty/stenting for 21 patients with intracranial vertebrobasilar stenosis (21 lesions). The procedure was performed under local anesthesia via the percutaneous transfemoral route. In 13 cases, we performed angioplasty only, while we used stents in 8 of 21 cases. The mean stenosis in 13 cases of angioplasty decreased from 76.2% to 26.4%, while 82.5% of the stenotic rate remarkably reduced to 11.3% in 8 cases of stenting. The 30-day morbidity and 30-day mortality rate were 4.8% and 0%, respectively. There was only 1 hemorrhagic complication (cerebellar hemorrhage) in case of stenting, and no ischemic events during or after the procedures. Restenosis (more than 50%) occurred in 3 of 21 cases (14.3%) during the mean follow-up period of 12 months. Our procedure-related morbidity and mortality rates were possibly not higher than those reported by other authors. In this study, angioplasty/stenting for intracranial vertebrobasilar artery stenosis was an effective treatment, but strict indications may be required because the procedure-related 30-day morbidity rate was still high compared with that of extracranial atherosclerotic stenosis, in addition to unknown natural history of intracranial vertebrobasilar stenosis.

Stent-angioplasty of intracranial vertebral and basilar artery stenoses in symptomatic patients

Background: To present our two-center treatment results with stent angioplasty of intracranial vertebrobasilar stenoses in symptomatic patients. Material and Methods: Between 2001 and 2003, 21 patients with 22 stenoses, refractory to medical therapy, who underwent elective stenting of intracranial vertebrobasilar stenoses were retrospectively analyzed. All patients had ischemic events clinically referable to the stenoses. Only high-grade stenoses of at least 80% were treated. Clinical evaluation was done based on the modified ranking scale (MRS). Results: In all cases, the stent deployment turned out to be technically successful and control angiography demonstrated the elimination of the high-grade stenoses. A minor residual stenoses was still detectable in six cases. According to the MRS, clinical outcome improved in the case of four patients, seemed unchanged in 14 and worsened in three. The clinical morbidity rate amounted to 14%. Clinical follow-up was available for 13 patients after 9 months with no recurrent symptoms and angiographic follow-up was available after 10 months. Re-stenoses occurred in two cases without clinical symptoms. Retreatment was not done. Conclusion: According to our data, stent angioplasty for symptomatic intracranial vertebrobasilar stenoses can be a treatment alternative in case of recurrent symptoms despite medical therapy; particularly, for stenoses of type Mori A or B.

Clinical Results of Percutaneous Transluminal Angioplasty and Stenting for Intracranial Vertebrobasilar Atherosclerotic Stenoses and Occlusions

Eighteen patients with intracranial vertebrobasilar stenosis and occlusion were treated by PTA or stenting. In 11 of 18 cases, only PTA was performed and in seven of 18 cases, we used stents. The mean stenosis before and after PTA/stenting was 82.8% and 22.3%, respectively. In 11 cases of PTA only, the stenotic rate decreased from 81.8% to 29.6%, while 85.0% of the stenotic rate remarkably reduced to 6.0% in seven cases of stenting. The 30 days morbidity and 30 days mortality rate were 5.5% and 5.5%, respectively. There was only one haemorrhagic complication (cerebellar haemorrhage) in cases of stenting, and no ischemic events during or after the procedures. Restenosis (more than 50% stenosis) occurred in four of 18 cases(22.2%) during mean followup period of 12 months. Two patients with VA occlusion before treatment, developed restenosis and reocclusion. Complete total occlusion seems to be a high-risk lesion and strict follow-up is required. In this study, PTA/stenting for intracranial vertebrobasilar artery stenosis or occlusion is an effective treatment, but strict indications may be required because procedure-related 30 days morbidity rate was 5.5% in addition to unclear natural history.

Stroke-free Survival and Its Determinants in Patients with Symptomatic Vertebrobasilar Stenosis: A Multicenter Study

We sought to determine the long-term stroke-free survival of patients who present with ischemic events related to intracranial vertebrobasilar stenosis. 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. 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. 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.