Background: Although offered at many centers, there is lack of evidence regarding whether stent placement is superior to best medical treatment for patients with vertebral artery stenosis in preventing new or recurrent brain ischemic events.
Methods: Three randomized controlled trials (RCTs) and 1 non randomized comparative study were included. We calculated pooled risk ratio (RR) and 95% confidence intervals (CI) using random effect model. End points were major adverse events including stroke, myocardial infarction (MI) or vascular events within 30 days, new stroke in vascular territory of target vertebral artery; and all cause mortality in follow up period.
Results: Of the 352 subjects (136 underwent stent placement) analyzed, 26 patients (7.4%) had stroke in the vascular territory of target vertebral artery. The risk of stroke in the vascular territory of target vertebral artery was not significantly different between the two groups (RR = 1.00; 95% CI 0.37-2.70; P =0.99). The risk of major adverse events including stroke, MI, and/or vascular events was non-significantly higher in patients who underwent stent placement (RR 2.62, 95% CI 0.56 - 12.19, p=0.22). No significant difference in all cause mortality was identified between the two groups on follow up at 3 years (RR 1.03, 95% CI 0.61-1.75, p=0.91).
Conclusion: We did not identify any reduction of stroke in Vascular territory of target vertebral artery in our analysis. Further studies are needed to ensure that stent placement performed in current practice is actually efficacious in patients with vertebral artery stenosis.