Stroke-free survival and its determinants in patients with symptomatic vertebrobasilar stenosis: A multicenter study

Adnan I. Qureshi, M. Fareed K. Suri, Wendy C. Ziai, Abutaher M. Yahia, Yousef Mohammad, Souvik Sen, Pinky Agarwal, Osama O. Zaidat, Jose I. Suarez, Robert J. Wityk, Christine A.C. Wijman, Gary K. Steinberg, Kai U. Frerichs, Robert M. Friedlander, Robert H. Rosenwasser

Research output: Contribution to journalArticlepeer-review

129 Scopus citations


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

Original languageEnglish (US)
Pages (from-to)1033-1040
Number of pages8
Issue number5
StatePublished - May 1 2003


  • Basilar artery
  • Intracranial stenosis
  • Ischemic stroke
  • Recurrence
  • Survival
  • Transient ischemic attack
  • Vertebral artery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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