Related Experiment Video

Updated: Jun 13, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

New England Medical Center Posterior Circulation Stroke Registry II. Vascular Lesions

Lr Caplan1, Rj Wityk, L Pazdera

  • 1Cerebrovascular Disease Sections of the New England Medical Center, Boston and the Beth Israel Deaconess Medical Center, Boston.

Journal of Clinical Neurology (Seoul, Korea)
|April 17, 2010
PubMed

Insights

Severe occlusive disease in posterior circulation arteries, particularly extracranial and intracranial vertebral arteries, is common. Prognosis varies by location, with basilar artery disease having the poorest outlook.

Area of Science:

  • Neuroscience
  • Vascular Neurology
  • Cerebrovascular Disease

Background:

  • Posterior circulation cerebrovascular disease affects a significant patient population.
  • Understanding the distribution and characteristics of occlusive lesions is crucial for diagnosis and treatment.

Purpose of the Study:

  • To analyze the frequency and location of severe occlusive lesions in the posterior circulation.
  • To investigate the relationship between lesion location, patient demographics, risk factors, and stroke mechanisms.
  • To determine the prognostic implications of different occlusive patterns.

Main Methods:

  • Retrospective analysis of 407 patients from the New England Medical Center Posterior Circulation Registry (NEMC-PCR).
  • Detailed assessment of extracranial vertebral arteries (ECVA), intracranial vertebral arteries (ICVA), basilar artery (BA), and posterior cerebral arteries (PCA).
  • Correlation of occlusive disease with patient comorbidities, stroke etiology (e.g., embolism, penetrating artery disease), and clinical outcomes.

Main Results:

  • Extracranial vertebral arteries (ECVA) and intracranial vertebral arteries (ICVA) were the most frequent sites of severe occlusive disease, followed by the basilar artery (BA).
  • Hypertension, smoking, and peripheral vascular disease were associated with ECVA disease, while diabetes and hyperlipidemia were more common with intracranial lesions.
  • Intra-arterial embolism was the primary mechanism for stroke in ECVA and ICVA occlusive disease. Basilar artery disease carried the poorest prognosis, while multiple arterial lesions surprisingly had the best prognosis.

Conclusions:

  • Occlusive disease in the posterior circulation commonly affects the vertebral arteries and basilar artery.
  • Risk factor profiles differ based on the location of occlusive lesions.
  • Understanding lesion location and associated stroke mechanisms is vital for predicting prognosis in posterior circulation stroke.

Keywords:
Basilar arteryBrain embolismBrain ischemiaBrainstemCerebellumPosterior cerebral arteriesPosterior circulationVertebral arteries

Related Concept Videos

Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation01:21

Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation

Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
Aneurysm II: Clinical Manifestations and Diagnostic Studies01:21

Aneurysm II: Clinical Manifestations and Diagnostic Studies

Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies01:20

Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies

The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
Ischemic Stroke l: Introduction01:15

Ischemic Stroke l: Introduction

Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
Imaging Studies VII: Vascular Imaging01:19

Imaging Studies VII: Vascular Imaging

DefinitionRenal angiography, also known as renal arteriography, is an imaging technique used to obtain a comprehensive view of blood flow and the vascular structure of blood vessels in the kidneys and surrounding areas.PurposeRenal angiography detects blood vessel abnormalities in the kidneys, such as aneurysms, stenosis, thrombosis, vascular tumors, and renal artery stenosis. It evaluates kidney function and guides interventional treatments like angioplasty or stent placement.Pre-Procedure...
Ischemic Stroke ll: Pathophysiology01:15

Ischemic Stroke ll: Pathophysiology

An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...