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Intracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry
M Müller-Küppers1, K J Graf, M S Pessin
1Universität Heidelberg, Germany.
Insights
Severe intracranial vertebral artery (ICVA) occlusive disease often involves multiple arteries and can lead to varied infarct patterns. Embolic infarcts in distal territories from ICVA lesions correlated with the worst patient outcomes.
Area of Science:
- Vascular Neurology
- Neuroimaging
- Cerebrovascular Disease
Background:
- Intracranial vertebral artery (ICVA) occlusive disease is a significant cause of posterior circulation stroke.
- Understanding the patterns of ischemia and infarction is crucial for patient management.
Purpose of the Study:
- To investigate the etiologies, lesion locations, and patterns of ischemia/infarction in patients with severe ICVA disease.
- To determine the outcomes associated with different infarct patterns and lesion locations.
Main Methods:
- Retrospective analysis of 75 patients from the New England Medical Center Posterior Circulation Registry.
- Utilized neuroimaging and vascular studies to assess ICVA lesions and infarcts.
Main Results:
- 39% had bilateral ICVA lesions; 24% had basilar artery disease; 36% had extracranial disease.
- Most common lesion site was distal ICVA. Proximal infarcts occurred in 25%, while 32% had infarcts in multiple territories.
- Distal territory infarcts from ICVA emboli (17%) and ICVA as an emboli recipient site (8%) were observed. Mortality was 13%.
Conclusions:
- Severe ICVA disease presents with diverse vascular and ischemic patterns.
- Distal infarcts due to emboli from ICVA lesions are associated with the poorest outcomes.
- Most surviving patients had favorable outcomes, but those with distal embolic infarcts experienced significant disability.
Abstract:
We studied 75 patients with severe intracranial vertebral artery (ICVA) occlusive disease from the New England Medical Center Posterior Circulation Registry to learn the etiologies and locations of the vascular lesions, the location and patterns of related ischemia and infarctions, and the outcomes. All patients had neuroimaging and vascular studies. Thirty-nine percent of patients had bilateral ICVA lesions. Twenty-four percent also had basilar artery disease and 36% had associated extracranial disease. The most common site of lesions was the distal ICVA after the origin of the posterior inferior cerebellar artery (PICA). Twenty-five percent of patients had only proximal intracranial posterior circulation territory infarcts (medullary and PICA cerebellar); 32% had infarcts that involved other intracranial territories in addition to the proximal territory. We found more distal intracranial territory infarcts resulting mainly from embolism from ICVA lesions than reported previously; this occurred in 17% of all patients. The ICVA was a recipient site for emboli in 8% of patients. Thirteen percent of patients died during follow-up. The outcome was favorable in most surviving patients. Three-fourths of them had no deficit or only slight disability. The patients with distal territory infarcts due to emboli from the ICVA had the worst outcome.