We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

The High Risk of Low Distal Flow

James F. Meschia, MD1
[+] Author Affiliations
1Department of Neurology, Mayo Clinic Florida, Jacksonville
JAMA Neurol. 2016;73(2):157-158. doi:10.1001/jamaneurol.2015.3885.
Text Size: A A A
Published online


Symptomatic atherosclerosis of the vertebral artery remains a challenging condition with no proven interventional therapy. Completed randomized trials of angioplasty with or without stenting involving patients with symptomatic vertebral artery stenosis include Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS),1 Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS),2 and Vertebral Artery Stenting Trial (VAST).3 As the largest (N = 115) completed trial, VAST illustrates many of the challenges of developing interventional therapy for this patient population. During a median follow-up of 3 years, 12% of the patients in the stenting group and 7% of those in the medical group developed stroke in the symptomatic vertebral arterial territory. The VAST investigators estimated that, with this cumulative absolute rate of stroke events in the medical group, 9500 patients would have to be randomized in a future trial to provide compelling evidence of a 20% reduction in risk. With this in mind, it may be more productive—indeed, perhaps necessary—to reserve the development of interventional therapy for higher-risk populations. It may be useful for future trials to focus on providing treatment for patients sooner after their qualifying event. In VAST, only one-third of the medical group was enrolled within 14 days of their qualifying event.

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles