Vertebral artery stenosis/occlusion
Applied
Type
AdditionConfidence
90%
Created
Mar 19, 2026
Evidence
2 sources
Rationale
The section was updated to include high-quality evidence from the CASSISS trial (Gao et al., 2026), which specifically addresses the lack of benefit for stenting in symptomatic intracranial stenosis, a key subset of vertebral artery disease. Additionally, the Japan Stroke Society Guideline (Miyamoto et al., 2022) was integrated to provide contemporary guideline support for medical management. Existing citations from the chapter were utilized to strengthen the original claims.
Evidence
Content Changes
removedadded
**Management approach:** Asymptomatic vertebral artery stenosis is managed medically. Symptomatic stenosis refractory to medical therapy may be considered for endovascular or open repair, though the benefit of routine stenting for stroke prevention remains unproven in randomized trials.trials [@markus2015]. For patients with symptomatic intracranial stenosis, the addition of stenting to medical therapy has not been shown to significantly reduce the risk of stroke or death compared to medical therapy alone [@gao2026]. Current clinical guidelines continue to recommend medical management as the primary approach for these patients [@miyamoto2022].