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Published on: February 22, 2013
Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry
R J Wityk1, H M Chang, A Rosengart
1Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
Occlusive disease of the proximal vertebral artery (V1 segment) is common in posterior circulation ischemia. This condition is often linked to other stroke mechanisms, but can be the primary cause in some patients.
Area of Science:
- Neurology
- Vascular Medicine
- Neuroscience
Background:
- Posterior circulation ischemia is a significant cause of stroke.
- Understanding the etiology of posterior circulation ischemia is crucial for effective treatment.
Observation:
- Occlusive disease of the proximal (V1) segment of the vertebral artery was identified in 20% of patients with posterior circulation ischemia.
- Patients were categorized into five groups based on V1 segment lesions and associated cerebrovascular conditions.
- Common risk factors included hypertension, smoking, and coronary artery disease.
Findings:
- Clinical features, infarct locations, and patient outcomes varied across the five patient groups.
- While often associated with other stroke mechanisms, V1 segment occlusive disease was the primary cause of ischemia in 9% of cases.
- Artery-to-artery embolism and hemodynamic transient ischemic attacks were notable associated conditions.
Implications:
- Occlusive disease of the V1 segment is a significant, though sometimes overlooked, cause of posterior circulation ischemia.
- Accurate diagnosis and classification of stroke mechanisms are essential for targeted therapeutic strategies.
- Further research into the specific role and management of V1 segment disease in posterior circulation stroke is warranted.
Objective:
To describe the clinical features of patients with occlusive disease of the proximal (V1) segment of the vertebral artery.
Design And Patients:
Patients with either occlusion or high-grade stenosis involving the V1 segment were chosen for study from the New England Medical Center Posterior Circulation Registry. The registry is a consecutive series of patients with signs and symptoms of posterior circulation ischemia seen at the New England Medical Center, Boston, Mass, during a 10-year period. Clinical features, radiographic findings, and patient outcome were reviewed.
Results:
Of the 407 patients in the registry, 80 (20%) had V1 segment lesions. Patients could be classified into 5 groups: (1) V1 disease and coexistent severe intracranial occlusive disease of the posterior circulation (n=22); (2) V1 disease with evidence of artery-to-artery embolism (n=19); (3) suspected V1 disease with artery-to-artery embolism, but with other potential causes of stroke or less certain vascular diagnosis (n=20); (4) V1 disease associated with hemodynamic transient ischemic attacks (n=13); and (5) proximal vertebral arterial dissection (n=6). Hypertension, cigarette smoking, and coronary artery disease were common risk factors. Clinical features, location of infarct, and outcome differed between groups and reflected the presumed mechanisms of stroke.
Conclusions:
Occlusive disease involving the V1 segment of the vertebral artery is common in patients with posterior circulation ischemia, but is often associated with other potential mechanisms of stroke. However, in a series of patients seen at a tertiary referral center, occlusive disease of the V1 segment was the primary mechanism of ischemia in 9% of patients.
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