Abstract Details

Title Comparison Between Medical Therapy And Endovascular Treatment Of Extracranial Atherosclerotic Vertebral Artery Disease: A Systematic Review

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-035

Objective To assess the potential benefit of endovascular treatment compared to medical treatment in patients with symptomatic extracranial vertebral artery (ECVA) atherosclerotic disease through a systematic literature review of published reports.

Background

Antiplatelet and anticoagulant therapy has been the standard of care for ECVA disease. Endovascular treatment is being used to reduce the risk of recurrent stroke and transient ischemic attack (TIA). However, it remains unclear which is better for long-term risk reduction.

Design/Methods We identified ECVA studies published between January 1966 and December 2017 using PubMed. The rates of stroke and stroke and/or death were estimated for best medical treatment and endovascular treatment at 1 month and last follow-up. A random effects model was used to calculate pooled proportions across studies and 95% confidence intervals.

Results Of a total of 57 reports reviewed, 8 studies reported outcomes in patients receiving medical treatment only (362 patients) and 49 studies reported upon patients treated with endovascular approach (2142 patients). The mean age of patients in the medical group was 65.6 years and 64.1 years in the endovascular group. The 30 day incidence of stroke was 26 (7.2%) in the medical treatment group compared to 18 (0.84%) in the endovascular group, resulting in a higher risk for patients in the best medical treatment when compared to endovascular treatment [PP 0.0559 vs. 0.0025; p-value = 0.0001)]. Similarly at follow-up, 33 (12.3 %) stroke were observed in the medical group compared to 51(2.4%) in the endovascular group [PP 0.1027 vs. 0.0109 ; p-value = 0.0001)]. There was also statistically significant difference in stroke-related death in the medical group versus endovascular group 12 (4.5 %) vs 1 (0.04%) [PP 0.03309 vs. 0.0000 ;p-value =0.001].

Conclusions

Our analysis demonstrated that endovascular treatment significantly reduced the risk of stroke and death when compared to best medical treatment at 30 days and at follow-up.

Authors/Disclosures
David Daniel, MD (Mount Sinai) PRESENTER	Dr. Daniel has nothing to disclose.
Muhammad Z. Memon, MD	Dr. Memon has nothing to disclose.
Shahram Majidi, MD (Icahn School of Medicine at Mount Sinai)	Dr. Majidi has nothing to disclose.
Haydee Del Calvo	No disclosure on file
Chen Chen, MD	No disclosure on file
	No disclosure on file
Hamza I. Maqsood, MD (Dept of Neurology)	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.

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