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Basilar and distal vertebral artery stenosis: long-term follow-up
Insights
Patients with blocked distal vertebral arteries (VA) or basilar arteries (BA) face a high stroke risk. This vertebrobasilar (VB) occlusive disease may lead to more brainstem ischemia than proximal VA disease.
Area of Science:
- Neurology
- Vascular Neurology
- Cerebrovascular Disease
Background:
- Vertebrobasilar (VB) occlusive disease affects the arteries supplying the brainstem and cerebellum.
- Distal VB occlusive disease involves stenosis or occlusion in the distal vertebral artery (VA) and/or basilar artery (BA).
Purpose of the Study:
- To evaluate the clinical outcomes and stroke risk in patients with distal VB occlusive disease.
- To compare the risk of brainstem ischemia in distal VB occlusive disease versus proximal VA occlusive disease.
Main Methods:
- Retrospective follow-up of 44 patients with >=50% stenosis in distal VA/BA.
- Average follow-up of 6.1 years, with angiography for symptoms.
- Comparison with a previous study of 93 patients with proximal VA occlusive disease.
Main Results:
- 18% of patients sustained a stroke, 5 in the VB territory (17x expected rate).
- 7 patients had definite VB transient ischemic attacks (TIA).
- Distal VB disease showed a higher risk for brainstem ischemia compared to proximal VA disease.
Conclusions:
- Distal VB occlusive disease presents a significant stroke risk, particularly affecting the brainstem.
- Patients with distal VB occlusive disease have a lower 5-year survival rate compared to the normal population.
- Early recognition and management of distal VB occlusive disease are crucial to mitigate ischemic events.
Abstract:
Forty-four patients with greater than or equal to 50% stenosis of a distal vertebral artery (VA) and/or basilar artery (BA) were followed up for an average of 6.1 years. Angiography was performed for definite vertebrobasilar (VB) transient ischemic attacks (TIA) in 19 (43%), for VB infarcts in 13 (30%) and for non localizing symptoms in 12 (27%). Stenosis in the BA with or without VA involvement was present in 28 patients (64%), while 16 patients (36%) had occlusive disease in one or both distal VA sparing the BA. In follow up, 7 patients (16%) had definite VB TIA and 3 patients had possible VB TIA. Eight patients (18%) sustained a stroke, 5 of which were in the VB territory. The observed stroke rate was 17 times the expected rate for a matched normal population. Eight patients died during follow up, three patients due to stroke (2 brainstem infarctions, one intraventricular hemorrhage). The observed 5 year survival rate was 78% compared to 90% in a matched normal population. In comparing this data with our previous study of 93 patients with proximal VA occlusive disease, distal VB occlusive disease appears to carry a higher risk for brainstem ischemia.