Vertebral Artery Stenosis: Medical or Surgical Tx?

What is the best way to treat symptomatic vertebral artery stenosis – medical therapy or percutaneous angioplasty, or both?

A meta-analysis covering 10 trials and 672 patients published in the Journal of Neurology compared medical therapy with medical therapy plus angioplasty.

No difference in any parameter studied, including any stroke, vascular death, and all cause death at 30 days, or at 1 year follow-up, was seen.

The authors concluded that vertebral artery angioplasty plus medical therapy may not be superior to medical therapy alone, and called for large randomized trials.