To the Editor Amin-Hanjani el al1 identified an important distinction in the natural history of atherosclerotic vertebrobasilar occlusive disease by separating the diagnosis of stenosis/occlusion with hemodynamic insufficiency. Could this be used to stratify patients more likely to benefit from intervention? Cautious optimism exists in the shadow of previous attempts to justify interventions based on hemodynamic compromise, like the Carotid Occlusion Surgery Study.2
Walcott BP, Choudhri O, Lawton MT. Hemodynamics in Symptomatic Atherosclerotic Vertebrobasilar Occlusive Disease. JAMA Neurol. 2016;73(6):759. doi:10.1001/jamaneurol.2016.0524
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