Stenting for Vertebral Artery Stenosis Shows No Clear Benefit Over Medication Alone
This Cochrane systematic review pooled data from four randomized controlled trials involving 429 patients with symptomatic vertebral artery stenosis to compare endovascular treatment (angioplasty with or without stenting) plus medical therapy versus medical therapy alone. Across all key outcomes — 30-day death or stroke, longer-term stroke in the treated artery territory, overall stroke, TIA, and death — no statistically clear difference was found between the two approaches. The certainty of evidence was rated low due to small sample sizes, early termination of three of the four trials, and unavoidable performance bias. The review concludes that current evidence neither confirms nor rules out a meaningful benefit from endovascular intervention, and calls for larger, better-designed trials.