Intracranial Vertebral Artery Disease in the New England Medical Center Posterior Circulation Registry

Müller-Küppers, M; Graf, K.J.; Pessin, Michael S.; DeWitt, L. D.; Caplan, Louis R.

doi:10.1159/000117427

Cited by 44 publications

(34 citation statements)

References 31 publications

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“…The 2 most common groups of patients with ICVA disease had embolism to the distal territory from the ICVA (32%) and multifocal TIAs in patients with extensive occlusive disease, usually involving both the ICVA and often the basilar artery as well (52%). 90 The patients with extensive ICVA and basilar artery disease had surprisingly good outcomes. Most had positionally related TIAs but seldom had disabling strokes.…”

Section: Vascular Occlusive Lesionsmentioning

confidence: 98%

“…Only 14 patients (19%) with severe ICVA disease had infarcts limited to the medulla or PICA cerebellum. 90 This is explained by the predominant location of occlusive disease within the ICVA beyond the PICA branches. The 2 most common groups of patients with ICVA disease had embolism to the distal territory from the ICVA (32%) and multifocal TIAs in patients with extensive occlusive disease, usually involving both the ICVA and often the basilar artery as well (52%).…”

Section: Vascular Occlusive Lesionsmentioning

confidence: 99%

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Posterior Circulation Ischemia: Then, Now, and Tomorrow

Caplan

2000

Stroke

172

103

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know and appreciate where we are now and where we are going in the future, it is essential to know where we have been. We cannot afford to relive and repeat the history of stroke every several decades. Posterior circulation stroke represents a microcosm of stroke in general. In this presentation I first review the development of ideas regarding brain and posterior circulation ischemia and its recognition and treatment. I then share some recent data from a large prospective registry of patients with posterior circulation ischemia. Finally, I look ahead to reflect on what I believe should be the future directions for research and for the care of patients with posterior circulation disease.Patients who present to physicians and hospitals with symptoms that suggest posterior circulation ischemia are handled differently from patients who have symptoms that suggest anterior circulation disease in the great majority of medical facilities in the United States and in the world. A patient who has an attack of dizziness with diplopia and ataxic gait usually has a brain image but seldom has vascular or cardiac investigations. A diagnosis of "vertebrobasilar insufficiency" (VBI) is often made, and physicians then debate whether or not to treat with warfarin-type anticoagulants, and, if so, for how long and at what intensity. In contrast, a patient who has right-hand weakness and aphasia is usually evaluated and treated quite differently at the very same facilities. Brain imaging, cardiac investigations, noninvasive vascular tests of the carotid and intracranial anterior circulation with the use of extracranial and transcranial ultrasound and/or MR angiography (MRA) and CT angiography, and catheter angiography are often pursued, depending on the local technological capabilities and experience of the treating physicians. An effort is made to identify the etiology and mechanism of the ischemia. Treatment is then chosen among a variety of possibilities (including carotid artery surgery, angioplasty, anticoagulants, and antiplatelet aggregants) depending on the nature, location, and severity of the occlusive disease and the mechanism of ischemia.Why should anterior and posterior circulation ischemia be handled so differently? Does this schizophrenic approach make sense? After all, the internal carotid artery and its branches and the vertebral (VA) and basilar arteries (BA) and their branches are just a few inches apart; they are made of the same coats and look the same under the microscope except for size. These vessels carry the same blood under the same blood pressure. The diseases that affect the blood vessels in the 2 circulations are the same. Do stroke mechanisms really differ between the 2 circulations? How did this differing approach originate, and does it continue to make sense today? These are some questions that I will attempt to answer as I review the development of ideas about posterior circulation ischemia and as I report recent data. Development of IdeasHerein I review how knowledge about the posterior circulation ...

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Section: Vascular Occlusive Lesionsmentioning

confidence: 98%

Section: Vascular Occlusive Lesionsmentioning

confidence: 99%

Posterior Circulation Ischemia: Then, Now, and Tomorrow

Caplan

2000

Stroke

172

103

View full text Add to dashboard Cite

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“…Death or severe disability was present in 18% of patients with ICVA occlusive disease compared to 30% in those with severe BA disease [27]. At follow-up examinations 3 years after discharge, 38% had no symptoms and 78% had no or only slight disability [29,30]. Most surprising was the relatively good outcomes in patients with bilateral ICVA disease (table 7).…”

Section: The New England Medical Center Posterior Circulation Registrmentioning

confidence: 99%

The Intracranial Vertebral Artery: A Neglected Species

Caplan¹

2012

Cerebrovasc Dis

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Among posterior circulation arteries, the intracranial vertebral artery (ICVA) has been given the least attention, especially concerning treatment of occlusive lesions. Early clinicopathological studies showed that the ICVA was often occluded in patients with lateral medullary and posterior inferior cerebellar infarcts. Severe stenosis or occlusion of the ICVA was the most common arterial lesion among the 408 patients in the New England Medical Center Posterior Circulation Registry (NEMC-PCR). In this registry, the distal portion of the artery was most often involved, sometimes with spread into the basilar artery. ICVA occlusive lesions were often bilateral and very often accompanied by basilar and cervical vertebral artery occlusive lesions. Patients with bilateral ICVA occlusions often had attacks of dizziness, blurred vision, and ataxia during months and years but rarely later developed disabling infarction. Most posterior circulation infarcts in patients with ICVA occlusive lesions were located in the middle and distal posterior circulation territories and were rostral to the medulla and inferior cerebellum. Although diagnostic techniques now image the ICVA and its lesions well, the optimal treatment of patients with various ICVA occlusive lesions has very rarely been analyzed or reported. The therapeutics of patients with ICVA disease is uncharted territory and begs for attention and clarification.

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“…Proksimal arteryel hastalığı (%17,5) grubunda sıklıkla lezyon İKVA'de saptandı. Son geniş serilerde etyoloji saptanamayan hastaların oranı %8-32 arasında bildirilmiştir (9,11,12,14,18,19,(21)(22)(23)(24)(25). Bizim serimizde bu oran %14,1 idi.…”

Section: Discussionunclassified

“…Ortalama yaş değerleri diğer çalışmalar ile uyumluydu. Önceki çalışmalarda var olan erkek cinsiyet hakimiyeti bizim serimizde istatistiksel anlamlılık oranında gözlenmedi (16,17,22).…”

Section: Discussionunclassified

Mechanisms, clinical features and risk factors for stroke in the posterior cerebral artery infarcts

Aydın¹,

Borucu²,

Pazarcı³

et al. 2015

tnd

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Bulgular: Otuz beş hasta (%61) PSA kortikal dal enfaktüsü geçirirken, 22 hastada (%39) kortikal ve derin PSA besleme alanında enfarkt saptandı. Etyolojiye bakıldığında her iki grupta da kardioembolizmin (n=27, %47) daha sık olduğu saptandı. Bunu sırayla entrensek PSA hastalığı (n=12, %21), proksimal arter hastalığı (n=10, %17), kriptojenik emboli (n=8, %15) izledi. İnme başlangıcında hastaların %52 baş ağrısı gösterdi. Hastaların %78'inde görme alanı bozuklukları, %54'ünde motor semptomlar, %24'ünde duysal semptomlar mevcuttu.Sonuç: PSA kortikal ve derin sulama alanındaki enfarktlarda kardiyojenik emboli ve entrensek PSA hastalığının daha sık olduğu düşünüldü. PSA kortikal dal enfarktı olanlar ile derin ve kortikal dal enfarktı olanlar arasında etyoloji ve risk faktörleri açısından anlamlı istatistiksel değişiklik saptanmadı. (Türk Nöroloji Dergisi 2015; 21:49-54) Anah tar Ke li me ler: Posterior serebral arter, akut serebral enfarktüs, etyoloji Objective: The objective of our study was to investigate the association between the infarcts in the cortical and deep posterior cerebral artery (PCA) perfusion area and the mechanisms of stroke, their clinical features and risk factors. Materials and Methods:Fifty seven patients who suffered strokes first time and have infarcts in the PCA perfusion area and admitted to our Neurology Clinics between January 2002 and August 2007 were included in this study. Subjects were divided in two groups as cortical branch infarct group and deep (thalamus) + cortical branch group. Patients were evaluated in four etiologic clusters; 1. Occlusion in the posterior cerebral artery or its branches. 2. Occlusion proximal to the posterior cerebral artery. 3. Cardio-embolic reasons. 4. Cryptogenic embolism group. All patients had cranial CT, MRI, neck Doppler USG, MRA or DSA, transesophageal or trans-thoracic echocardiography, hematologic and vasculytic investigations. Risk factors in all patients were recorded.

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Intracranial Vertebral Artery Disease in the New England Medical Center Posterior Circulation Registry

Cited by 44 publications

References 31 publications

Posterior Circulation Ischemia: Then, Now, and Tomorrow

Posterior Circulation Ischemia: Then, Now, and Tomorrow

The Intracranial Vertebral Artery: A Neglected Species

Mechanisms, clinical features and risk factors for stroke in the posterior cerebral artery infarcts

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