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Outcome at 30 Days in the New England Medical Center Posterior Circulation Registry
Thomas A. Glass, PhD;
Patricia M. Hennessey;
Ladislav Pazdera, MD;
Hui-Meng Chang, MD;
Robert J. Wityk, MD;
L. Dana Dewitt, MD;
Michael S. Pessin, MD;
Louis R. Caplan, MD
Arch Neurol. 2002;59:369-376.
Background Vertebrobasilar disease is generally considered a condition with a poor
prognosis because of high rates of mortality and severe disability.
Objective To compare the outcomes of 407 patients entered in the New England Medical
Center Posterior Circulation Registry with the reported results of other studies.
Results In contrast, among 407 patients prospectively and consecutively studied
in the New England Medical Center Posterior Circulation Registry, we found
a low mortality rate at 30 days after onset (3.6%) and relatively low rates
of major disability (18% using a Modified Rankin Disability Scale score).
Thirty days after stroke, 28% of the patients had no disability and 51% had
only a minor disability. Stroke location, stroke mechanism, and arteries involved
predicted outcome. Basilar artery involvement, embolic stroke mechanism, and
multiple posterior circulation intracranial territory involvement correlated
with poor outcome. Patients with lesions in the basilar artery were 5 times
more likely to have a poor outcome independent of other factors. Lesions in
the middle and distal territories were each associated with a poor outcome
in one third of the patients.
Conclusion In contrast with previous reports, we found that vertebrobasilar occlusive
disease consists of a variety of different stroke mechanisms and vascular
lesions, many with a good prognosis.
From the Department of Epidemiology, Johns Hopkins School of Hygiene
and Public Health, Baltimore, Md (Dr Glass); Williams College, Wellesley,
Mass (Ms Hennessey); Department of Neurology, Singapore General Hospital (Dr
Chang); Department of Neurology, The Johns Hopkins School of Medicine, Baltimore
(Dr Wityk); Newton Wellesley Hospital, Newton, Mass (Dr Dewitt); Department
of Neurology, New England Medical Center, Tufts University, Boston, Mass (Dr
Pessin); and Department of Neurology, Harvard Medical School and the Division
of Cerebrovascular Disease, Beth Israel Deaconess Medical Center, Boston (Dr
Caplan). Dr Pazdera is in private practice in Rychnov, Czech Republic.
Dr Pessin is deceased.
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