New England medical center posterior circulation registry

Objectives: Vertebrobasilar stenosis is frequent in patients with posterior circulation stroke and it increases risk of recurrence. We investigated feasibility of duplex ultrasonography (DUS) for screening for extracranial vertebral artery stenosis and compared it with CT angiography (CTA). Materials and Methods:We gathered data on 337 consecutive patients who had DUS because of posterior circulation stroke or TIA. Matching CTA studies were retrieved and used as reference. Stenosis on CTA was considered "significant" if >50%, at DUS if Peak Systolic Velocity (PSV) > 140 cm/s for the V1 segment and PSV > 125 cm/s for the V2 segment. We determined the area under the ROC curve (AUROC). In addition, we calculated which PSV cut-off value resulted in highest sensitivity with acceptable specificity.Results: DUS was able to make an adequate measurement in 378 of 674 V1 segments and 673 of 674 V2 segments. DUS detected a significant stenosis in 52 of 378 V1 segments; 12 were confirmed by CTA (AUROC 0.73, 95% Confidence Interval 0.63-0.83).The optimal DUS PSV cut-off value for this segment was 90 cm/s. For the V2 segment there were too few stenoses to allow reliable assessment of diagnostic characteristics of DUS. Conclusions:Although DUS has a fair AUROC for detecting significant stenosis, adequate assessment of the V1 segment is often not possible due to anatomic difficulties.Assessment of the V2 segment is feasible but yielded few stenoses. Hence, we consider usefulness of DUS for screening of extracranial vertebral artery stenosis limited. K E Y W O R D SCT angiography, duplex ultrasonography, vertebral artery, vertebrobasilar stroke

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“…we found approximately the same prevalence of significant vertebral artery stenosis with CTA (Caplan et al, 2004;Marquardt et al, 2009). …”

Section: Discussionsupporting

confidence: 71%

Duplex ultrasonography for the detection of vertebral artery stenosis

et al. 2017

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“…Furthermore, multiple stenoses in the posterior circulation are frequent, accounting for 36.4% of patients in a posterior circulation stroke registry study, 12 and the prognosis of patients with concurrent intracranial and extracranial stenoses was worse as shown in a Chinese stroke population study. 4 A stent-placement procedure of intracranial VBA and VAO tandem stenoses is technically more complicated than that of an isolated stenosis.…”

Section: Discussionmentioning

confidence: 98%

Long-Term Outcome of Tandem Stenting for Stenoses of the Intracranial Vertebrobasilar Artery and Vertebral Ostium

Wong²,

Jiang³

2009

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Patients with symptomatic atherosclerotic stenosis of the intracranial vertebrobasilar artery (VBA) have a poor prognosis, and those with coexistent intracranial and extracranial stenoses have worse outcomes despite medical therapy. Our aim was to study the long-term outcome of patients with symptomatic atherosclerotic tandem stenoses at the intracranial VBA and the vertebral artery ostium (VAO) after elective stent placement.

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“…However, reports of migratory cardioembolic events that occlude penetrating vessel ostia are reported, but their involvement is typically greater than 1 cm in parenchymal size. Cardioembolic stroke affecting the posterior circulation accounts for ≤25% of posterior circulation ischemic events in some registries [18][19][20][21][22][23][24][25][26].…”

Section: Evaluation Of Patients At Risk For Cardioembolic Strokementioning

confidence: 99%

Prevention of Cardioembolic Stroke

Freeman

Aguilar

2011

Neurotherapeutics

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Cardiac causes of ischemic stroke lead to severe neurological deficits from large intracranial artery occlusion compared to small vessel ischemic stroke. The most common cause of cardioembolic stroke is atrial fibrillation (AF), which has an increasing incidence with age. AF stroke trials demonstrate that anti-coagulation is superior to anti-platelet therapy in terms of ischemic stroke prevention. Recently, warfarin was compared with dabigatran, an oral, direct thrombin inhibitor, and was found to be at least equally effective in reducing ischemic stroke with less intracranial bleeding risk. Future research is investigating other direct thrombin inhibitors as potential alternatives to warfarin, which has a narrow therapeutic index, requires frequent blood monitoring, has multiple drug interactions, and a higher rate of intracranial bleeding. Other causes of cardioembolic stroke include myocardial infarction, left ventricular thrombus, reduced ejection fraction, valvular abnormalities, and endocarditis. Patent foramen ovale is a common finding on echocardiograms in patients with and without stroke (up to 20% of the population), and it is a controversial source of cryptogenic stroke. The best way to prevent cardioembolic stroke remains early detection and treatment of AF, and treating the underlying stroke mechanism. Cardiac magnetic resonance imaging is an emerging technology and reveals some sources of cardiac embolism missed by echocardiography, and might provide an additional diagnostic tool in investigating cardioembolic stroke.

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New England medical center posterior circulation registry

Cited by 424 publications

References 50 publications

Duplex ultrasonography for the detection of vertebral artery stenosis

Duplex ultrasonography for the detection of vertebral artery stenosis

Long-Term Outcome of Tandem Stenting for Stenoses of the Intracranial Vertebrobasilar Artery and Vertebral Ostium

Prevention of Cardioembolic Stroke

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