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Embolism from vertebral artery origin occlusive disease
L R Caplan1, P Amarenco, A Rosengart
1Department of Neurology, New England Medical Center, Boston, MA 02111.
Insights
Severe vertebral artery (VA) disease can cause posterior circulation strokes via embolism. Atherosclerosis at the VA origin shares risk factors with internal carotid artery disease, leading to similar stroke mechanisms.
Area of Science:
- Neurology
- Vascular Neurology
- Cerebrovascular Disease
Background:
- Vertebral artery (VA) origin disease is a significant cause of posterior circulation stroke.
- Atherosclerosis is a common pathology affecting the VA origin.
- Intracranial embolism from VA lesions can lead to vertebrobasilar territory infarcts.
Purpose of the Study:
- To describe the clinical and angiographic features of patients with severe VA origin disease and posterior circulation embolism.
- To identify the common embolic sites and resulting infarct patterns.
- To compare the characteristics of VA origin atherosclerosis with internal carotid artery origin atherosclerosis.
Main Methods:
- Retrospective case series of 10 patients with severe VA origin occlusive disease.
- Clinical presentation, neuroimaging (angiography), and stroke locations were analyzed.
- Comparison of risk factors and demographics with internal carotid artery disease.
Main Results:
- Seven patients had complete VA occlusions; three had severe atherostenosis.
- Most common embolic sites were the VA-posterior inferior cerebellar artery region (8) and distal basilar artery (BA) (7).
- Cerebellar infarction was the most frequent clinical presentation; pontine infarction occurred in two patients due to BA embolism.
Conclusions:
- Severe VA origin atherosclerosis can lead to significant posterior circulation strokes through intra-arterial embolism.
- VA origin disease shares risk factors and embolic mechanisms with internal carotid artery origin disease.
- Understanding these similarities is crucial for stroke prevention and management strategies.
Abstract:
We report 10 patients with severe occlusive disease of the vertebral artery (VA) origin in the neck with intra-arterial embolism to the posterior circulation. The VA lesions in seven patients were complete occlusions, and three patients had severe atherostenosis. All patients had strokes in the vertebrobasilar territory. The most frequent recipient sites of intra-arterial embolism were the intracranial VA-posterior inferior cerebellar artery region (8), and the distal basilar artery (BA) and its superior cerebellar and posterior cerebral artery branches (7). Two patients had pontine infarction due to BA embolism. The most common clinical signs were due to cerebellar infarction. Atherosclerotic disease of the VA origin has features in common with disease of the internal carotid artery origin. Both have similar risk factors and demography, and each can cause strokes by intracranial intra-arterial embolism.