{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:24:14Z","timestamp":1760955854974},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>The VERiTAS (Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke) study demonstrated posterior circulation distal flow status, determined by quantitative magnetic resonance angiography, is a robust predictor of vertebrobasilar stroke risk in patients with symptomatic atherosclerotic vertebrobasilar disease. Flow-compromised high-risk patients may benefit from flow-restoring endovascular procedures, such as submaximal angioplasty. In this study, we examine the cost-effectiveness of quantitative magnetic resonance angiography screening to identify patients who may benefit from submaximal angioplasty to restore vertebrobasilar flow.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>A Markov model was created comparing a no screening strategy with standard medical management alone and a screening strategy involving quantitative magnetic resonance angiography imaging and submaximal angioplasty for treatable patients with low vertebrobasilar flow for a 30-year time horizon. Outcomes included quality-adjusted life years (QALY) and lifetime costs. Rates of stroke and death were obtained from VERiTAS data, and disability rates and costs were derived from VERiTAS and the literature. A sensitivity analysis was performed with periprocedural stroke rate from angioplasty the primary variable of interest.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>At a 6% periprocedural stroke risk, the screening strategy saved an average of 0.364 QALYs per patient and a lifetime cost savings of $7312 versus the no screening strategy. Among patients with low flow suitable for intervention, the benefit was substantially higher, averaging 1.485 QALYs saved and lifetime cost savings of $21\u2009294. Across the entire cohort, QALY savings were observed at the end of the first year and economic savings at year 6. The benefit of screening declined at higher periprocedural risk.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Quantitative magnetic resonance angiography screening and submaximal angioplasty with 6% periprocedural risk in suitable patients are cost effective both in terms of QALY and lifetime costs for patients with symptomatic vertebrobasilar occlusive disease. With potential health and economic savings, a clinical trial examining the periprocedural risk of submaximal angioplasty is warranted.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT00590980.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.118.022339","type":"journal-article","created":{"date-parts":[[2018,7,16]],"date-time":"2018-07-16T09:05:24Z","timestamp":1531731924000},"page":"1953-1959","update-policy":"http:\/\/dx.doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Cost-Effectiveness of Quantitative Magnetic Resonance Angiography Screening and Submaximal Angioplasty for Symptomatic Vertebrobasilar Disease"],"prefix":"10.1161","volume":"49","author":[{"given":"Darian R.","family":"Esfahani","sequence":"first","affiliation":[{"name":"From the Departments of Neurosurgery (D.R.E., X.D., L.R.-F., F.T.C., S.A.-H.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dilip","family":"Pandey","sequence":"additional","affiliation":[{"name":"Neurology and Rehabilitation (D.P.), University of Illinois at Chicago"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinjian","family":"Du","sequence":"additional","affiliation":[{"name":"From the Departments of Neurosurgery (D.R.E., X.D., L.R.-F., F.T.C., S.A.-H.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Rose-Finnell","sequence":"additional","affiliation":[{"name":"From the Departments of Neurosurgery (D.R.E., X.D., L.R.-F., F.T.C., S.A.-H.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fady T.","family":"Charbel","sequence":"additional","affiliation":[{"name":"From the Departments of Neurosurgery (D.R.E., X.D., L.R.-F., F.T.C., S.A.-H.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colin P.","family":"Derdeyn","sequence":"additional","affiliation":[{"name":"Departments of Radiology and Neurology, University of Iowa (C.P.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sepideh","family":"Amin-Hanjani","sequence":"additional","affiliation":[{"name":"From the Departments of Neurosurgery (D.R.E., X.D., L.R.-F., F.T.C., S.A.-H.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of the VERiTAS Study Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.20204"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62038-3"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.1693"},{"key":"e_1_3_4_5_2","first-page":"525","article-title":"Intracranial angioplasty without stenting for symptomatic atherosclerotic stenosis: long-term follow-up.","volume":"26","author":"Marks MP","year":"2005","unstructured":"Marks, MP, Marcellus, ML, Do, HM, Schraedley-Desmond, PK, Steinberg, GK, Tong, DC. 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