Assessing Risk of Stroke and Complications of Stenting in Vertebral Artery Stenosis Patients in Hong Kong: A Retrospective Study

Abstract

Objective: Given the unclear efficacy of vertebral artery (VA) stenting in reducing stroke risk and future complications, this study aimed to examine the long-term outcomes of symptomatic VA stenosis patients who underwent stenting to elucidate the clinical impact of the procedure. Methods: Patients with VA stenosis who received stenting from Queen Mary Hospital, Hong Kong from 2007 to 2017 were identified using the Hospital Authority’s Clinical Management System. Demographic factors, clinical characteristics, surgical outcomes, and adverse events during follow-up were evaluated via retrospective review. The primary outcome was the occurrence of fatal/non-fatal stroke in any arterial territory during follow-up. Secondary outcomes included the occurrence of posterior circulation stroke, fatal/non-fatal stroke within 90 days of procedure, death of any cause, and VA restenosis. Results: The patient cohort consisted of 28 patients (21 men and 7 women) with mean age 64.2 years at operation and mean follow-up 59.8 months. In all, 11 (39.3%) patients had left VA stenosis, eight (28.6%) patients had right VA stenosis, and nine (32.1%) patients had bilateral VA stenosis. Fourteen (50%) patients qualified for stenting owing to previous ischaemic stroke and nine (32.1%) patients qualified owing to imaging evidence of cerebral ischaemia. During follow-up, three (10.7%) patients suffered stroke and six (21.4%) patients required restenosis. There was one case of fatal stroke and two patients died of non-stroke causes. Conclusion: Our results demonstrate a high stroke and restenosis risk among Hong Kong VA stenosis patients who received stenting. Outcome comparisons with patients who did not receive surgical intervention should be made to corroborate the study findings.