Vertebrobasilar (VB), or posterior circulation, stroke accounts for 20 % of all strokes, but its investigation and treatment have received less attention than carotid stroke. Although it was previously thought that recurrent stroke risk was lower than that for carotid stroke, this has been shown not to be the case when the high early risk of recurrent stroke is captured.1 This finding was confirmed in 2 recent prospec-tive studies: 1 population-based (Oxford Vascular Study, OXVASC)2 and 1 hospital register–based study (St. George’s Study).3 Both showed VB stenosis was a major predictor of recurrent stroke, particularly in the first month. These find-ings suggest that more intensive medical therapy, and possibly revascularization with stenting, should be considered for VB transient ischemic attack (TIA) or stroke, in the same way as carotid endarterectomy has become routine for symptomatic carotid artery stenosis. However, although both studies found an increased risk of stroke associated with VB stenosis, nei-ther alone had the power to determine the relationship between the site of stenosis and recurrent stroke risk nor to determine whether the increased risk was independent of other cardio-vascular risk factors. We performed a pooled analysis using individual patient data from both studies to answer these ques-tions. We also performed a systematic review to identify any additional data relating the presence of recently symptomatic VB stenosis to recurrent stroke risk
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