 |
|
Basilar Artery Occlusive Disease in the New England Medical Center Posterior Circulation Registry
Barbara Voetsch, MD, PhD;
L. Dana DeWitt, MD;
Michael S. Pessin, MD;
Louis R. Caplan, MD
Arch Neurol. 2004;61:496-504.
Background Most reports on basilar artery (BA) occlusive disease have retrospectively described single cases or small patient series.
Objective To assess clinical and vascular features, stroke mechanisms, etiologies, and outcome of moderate to severe BA occlusive disease among 407 patients in the New England Medical Center Posterior Circulation Registry, the largest prospective series of consecutively collected patients with posterior circulation ischemia to date.
Results We studied 87 patients and identified 3 patient groups with distinct vascular, clinical, etiological, and prognostic characteristics: isolated BA disease (39 patients [44.8%]), BA involvement as part of widespread posterior circulation atherosclerosis (36 patients [41.4%]), and embolism to the BA (12 patients [13.8%]). Vascular risk factors were common and often multiple. Most patients (54 [62.1%]) had involvement of the midportion of the BA. Fifty-eight patients (66%) initially had transient ischemic attacks, of whom 34 (58.6%) progressed to stroke. Transient ischemic attacks were usually multiple, lasted for several months, and increased in frequency as the stroke approached. When an infarct was present, the middle posterior intracranial territory was most often involved (66 patients [75.9%]). Outcome was much better than previously assumed. The mortality rate was 2.3%, and 62 patients (almost 75%) had minor or no deficits at follow-up. Outcome was best among patients with widespread atherosclerotic disease and worst in 7; (58.3%, with major disability) of 12 patients with embolism to the BA. Distal territory involvement, embolism, BA occlusion, decreased level of consciousness, tetraparesis, and abnormal pupils were significant predictors of poor outcome.
Conclusion Inclusion of patients into 1 of the BA groups and early identification of predictive outcome factors guide diagnostic evaluation and treatment.
From the Whitaker Cardiovascular Institute, Evans Department of Medicine, Boston University School of Medicine (Dr Voetsch), the Department of Neurology, Harvard Medical School (Drs Voetsch and Caplan), the Division of Cerebrovascular Disease, Beth Israel Deaconess Medical Center (Drs Voetsch and Caplan), and the Department of Neurology, New England Medical Center, Tufts University, (Drs DeWitt, Pessin, and Caplan) Boston, Mass; and Newton-Wellesley Hospital, Newton, Mass (Dr DeWitt).
Dr Pessin is deceased.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
Basilar Occlusive Disease: The Descent of the Feared Foe?
Bartlomiej Piechowski-Józwiak and Julien Bogousslavsky
Arch Neurol. 2004;61(4):471-472.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Impact of posterior communicating artery on basilar artery steno-occlusive disease
Hong et al.
J. Neurol. Neurosurg. Psychiatry 2009;80:1390-1393.
ABSTRACT
| FULL TEXT
Use of Intravenous Tissue Plasminogen Activator in a 16-Year-Old Patient with Basilar Occlusion
Heil et al.
J Child Neurol 2008;23:1049-1053.
ABSTRACT
Intra-Arterial Thrombolysis for Basilar Artery Thrombosis: Trial It
Powers
Stroke 2007;38:704-706.
ABSTRACT
| FULL TEXT
Intra-Arterial Thrombolysis for Basilar Artery Thrombosis and Stenting for Asymptomatic Carotid Disease: Implications and Future Directions
Hachinski
Stroke 2007;38:721-722.
FULL TEXT
Distribution and outcome of symptomatic stenoses and occlusions in patients with acute cerebral ischemia.
Weimar et al.
Arch Neurol 2006;63:1287-1291.
ABSTRACT
| FULL TEXT
Use of mechanical extraction devices in basilar artery occlusion
Favrole et al.
J. Neurol. Neurosurg. Psychiatry 2005;76:1462-1464.
ABSTRACT
| FULL TEXT
Outcome in patients with basilar artery occlusion treated conventionally
Schonewille et al.
J. Neurol. Neurosurg. Psychiatry 2005;76:1238-1241.
ABSTRACT
| FULL TEXT
Initial Glasgow Coma Scale Score Predicts Outcome Following Thrombolysis for Posterior Circulation Stroke
Tsao et al.
Arch Neurol 2005;62:1126-1129.
ABSTRACT
| FULL TEXT
Vertebrobasilar Disease
Savitz and Caplan
NEJM 2005;352:2618-2626.
FULL TEXT
The influence of letrozole on serum lipid concentrations in postmenopausal women with primary breast cancer who have completed 5 years of adjuvant tamoxifen (NCIC CTG MA.17L)
Wasan et al.
Ann Oncol 2005;16:707-715.
ABSTRACT
| FULL TEXT
Basilar Occlusive Disease: The Descent of the Feared Foe?
Piechowski-Jozwiak and Bogousslavsky
Arch Neurol 2004;61:471-472.
FULL TEXT
|
