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Transluminal angioplasty and stenting versus conservative treatment in patients with symptomatic basilar artery stenosis

Perspective for future clinical trials

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Abstract

Purpose

Two recent randomized controlled trials (RCT) consistently showed superiority of aggressive medical treatment versus percutaneous transluminal angioplasty and stenting (PTAS) in patients with intracranial artery stenosis. Patients with symptomatic basilar stenosis have a higher long-term risk of recurrent stroke compared to patients with anterior circulation stenosis but no study has specifically focused on the role of PTAS in this subgroup. The aim of our study was to investigate the subgroup of patients with symptomatic basilar artery stenosis to find evidence for the feasibility of a future clinical trial.

Methods

Patients with ischemic stroke caused by a symptomatic basilar stenosis and admitted to five German tertiary care hospitals were included in this multicenter effectiveness study. Primary outcome was a composite endpoint of stroke recurrence, clinically relevant restenosis, progression and death. Shared frailty Cox regression models were used to compare outcome rates between groups.

Results

Of the 139 patients included in the study 79 (57 %) underwent PTAS and 60 (43 %) conservative treatment alone. The median follow-up period was 300 (IQR 18–738) days. Risks of the primary composite outcome (hazard ratio HR 0.49, 95 % confidence interval CI 0.25–0.97, p = 0.039) and of the key secondary outcomes recurrent stroke (HR 0.42, 95 % CI 0.19–0.95, p = 0.037) and clinically relevant restenosis/progression (HR 0.12, 95 % CI 0.03–0.59, p = 0.009) were lower in patients with PTAS compared to conservative treatment. There was no difference in all-cause mortality between groups (HR 0.98, 95 % CI 0.19–5.09, p = 0.979).

Conclusion

In this retrospective study we could not reproduce the findings from large RCTs on intracranial stenting. Our data could be considered as a basis for a prospective study on patient selection for PTAS in the basilar artery.

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Authors and Affiliations

  1. Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany

    Ilko L. Maier, Mathias Bähr & Jan Liman

  2. Research group Epidemiological and Statistical Methods (ESME), Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany

    André Karch & Rafael T Mikolajczyk

  3. Department of Neuroradiology, University Medicine Göttingen, Göttingen, Germany

    Christina Lipke, Daniel Behme, Michael Knauth & Kai Kallenberg

  4. Department of Neuroradiology, University Hospital Cologne, Cologne, Germany

    Anastasios Mpotsaris, Christoph Kabbasch & Thomas Liebig

  5. Department of Neurosurgery, University Hospital Cologne, Cologne, Germany

    Andrea Faymonville

  6. Department of Neurology, University Hospital Aachen, Aachen, Germany

    Arno Reich

  7. Department of Neuroradiology, University Hospital Aachen, Aachen, Germany

    Omid Nikoubashman

  8. Department of Neuroradiology, , University Hospital Hamburg-Eppendorf, Hamburg-Eppendorf, Germany

    Jan-Hendrik Buhk

  9. Department of Neuroradiology, Klinikum Vest, Recklinghausen, Germany

    Patrick von Schoenfeld

  10. Department of Neuroradiology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany

    Werner Weber

Authors
  1. Ilko L. Maier
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  2. André Karch
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  3. Christina Lipke
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  4. Daniel Behme
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  5. Anastasios Mpotsaris
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  7. Thomas Liebig
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  8. Andrea Faymonville
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  9. Arno Reich
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  10. Omid Nikoubashman
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  11. Jan-Hendrik Buhk
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  12. Patrick von Schoenfeld
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  13. Werner Weber
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  14. Rafael T Mikolajczyk
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  15. Mathias Bähr
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  16. Michael Knauth
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  17. Kai Kallenberg
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  18. Jan Liman
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Corresponding authors

Correspondence to Ilko L. Maier or Jan Liman.

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Conflict of interests

I.L. Maier, A. Karch, C. Lipke, D. Behme, A. Mpotsaris, C. Kabbasch, T. Liebig, A. Faymonville, A. Reich, O. Nikoubashman, P. von Schoenfeld, W. Weber, M. Bähr, M. Knauth, K. Kallenberg, and J. Liman state that they have no conflict of interests. J.-H. Buhk received remuneration as a consultant for DePuy Codman. R.T. Mikolajczyk was involved in studies funded by Bayer Pharma AG while working for his previous employer.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors. Confirmation was received from the responsible ethics committee that approval was not necessary due to the nature of the study.

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Author contributions

Kai Kallenberg and Jan Liman contributed equally to the study.

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Maier, I.L., Karch, A., Lipke, C. et al. Transluminal angioplasty and stenting versus conservative treatment in patients with symptomatic basilar artery stenosis. Clin Neuroradiol 28, 33–38 (2018). https://doi.org/10.1007/s00062-016-0528-x

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  • DOI: https://doi.org/10.1007/s00062-016-0528-x

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