Universität zu Köln

Maier, Ilko L., Karch, Andre ORCID: 0000-0003-3014-8543, Lipke, Christina, Behme, Daniel, Mpotsaris, Anastasios ORCID: 0000-0002-1275-8164, Kabbasch, Christoph, Liebig, Thomas, Faymonville, Andrea, Reich, Arno, Nikoubashman, Omid, Buhk, Jan-Hendrik, von Schoenfeld, Patrick, Weber, Werner, Mikolajczyk, Rafael T., Baehr, Mathias, Knauth, Michael, Kallenberg, Kai and Liman, Jan (2018). Transluminal angioplasty and stenting versus conservative treatment in patients with symptomatic basilar artery stenosis Perspective for future clinical trials. Clin. Neuroradiol., 28 (1). S. 33 - 39. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1869-1447

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Abstract

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. 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. 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). 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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Maier, Ilko L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Karch, Andre UNSPECIFIED orcid.org/0000-0003-3014-8543 UNSPECIFIED Lipke, Christina UNSPECIFIED UNSPECIFIED UNSPECIFIED Behme, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Mpotsaris, Anastasios UNSPECIFIED orcid.org/0000-0002-1275-8164 UNSPECIFIED Kabbasch, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Liebig, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Faymonville, Andrea UNSPECIFIED UNSPECIFIED UNSPECIFIED Reich, Arno UNSPECIFIED UNSPECIFIED UNSPECIFIED Nikoubashman, Omid UNSPECIFIED UNSPECIFIED UNSPECIFIED Buhk, Jan-Hendrik UNSPECIFIED UNSPECIFIED UNSPECIFIED von Schoenfeld, Patrick UNSPECIFIED UNSPECIFIED UNSPECIFIED Weber, Werner UNSPECIFIED UNSPECIFIED UNSPECIFIED Mikolajczyk, Rafael T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Baehr, Mathias UNSPECIFIED UNSPECIFIED UNSPECIFIED Knauth, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Kallenberg, Kai UNSPECIFIED UNSPECIFIED UNSPECIFIED Liman, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-193285
DOI:	10.1007/s00062-016-0528-x
Journal or Publication Title:	Clin. Neuroradiol.
Volume:	28
Number:	1
Page Range:	S. 33 - 39
Date:	2018
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1869-1447
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language VERTEBROBASILAR STENOSIS; RECURRENT STROKE; MANAGEMENT; PROGNOSIS; RISK Multiple languages Clinical Neurology; Radiology, Nuclear Medicine & Medical Imaging Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/19328