Basilar and distal vertebral artery stenosis: long-term follow-up.

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.

Use of Quantitative Magnetic Resonance Angiography to Stratify Stroke Risk in Symptomatic Vertebrobasilar Disease

“…3,4 Mouffarij et al reported an 80% stroke-free survival at 2 years in a retrospective study of patients with distal vertebral artery or BA stenosis of Ն50%. 16 The recent study by Qureshi et al of 102 patients with symptomatic intracranial VBD (Ͼ50% stenosis) demonstrated that 14% of patients experienced recurrent stroke, with a stroke-free survival of 72% at 2 years. 3 In comparison, our group of medically managed patients with intracranial VBD (nϭ34) had a better overall 2-year stroke-free survival of 92%, which likely reflects a preselection of patients felt to be at high risk (because of low flow), for intervention.…”

Three-dimensional transcranial Doppler blood flow mapping in patients with cerebrovascular disorders.

“…22 Stenoses can be detected and followed noninvasively using TDFM, and the effectiveness of anticoagulation and fibrinolysis can be assessed directly. 23 In patients with extracranial ICA occlusions, collateral blood flow pathways and patency of the MCA were clearly demonstrated by TDFM.…”

Long-term prognosis of infratentorial transient ischemic attacks and minor strokes.

“…In previous studies the prognosis of patients with proximal vertebral artery stenosis has been assumed to be better than that of patients with distal stenosis. 28 Further statistical differentiation with regard to the site of obliteration was not possible in our study because of the limited number of cases. The long-term prognosis of patients with basilar artery stenosis or occlusion did not differ from that of other patients, although both types of patients were followed up for comparable times.…”