Occlusion of the intradural vertebrobasilar artery

Thompson, Joseph R.; Simmons, Charles R.; Hasso, Anton N.; Hinshaw, David B.

doi:10.1007/bf00418619

Cited by 47 publications

(8 citation statements)

References 17 publications

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“…24 Our results suggest that a bilateral vertebral artery occlusion is more common than may have been suspected by other authors. 2325 In this study, we have described the early symptoms and signs and the temporal profile in 85 patients with angiographically proven basilar artery occlusion.…”

Section: -22contrasting

confidence: 48%

Clinical features of proven basilar artery occlusion.

Ferbert

Brückmann

Drummen

1990

Stroke

204

116

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Our study describes the early symptoms and signs of 85 patients with either basilar artery occlusion or bilateral distal vertebral artery occlusion documented by selective angiography. The most common prodromal symptoms were vertigo, nausea, and headache, which occurred during the 2 weeks before the stroke. Angiographic findings of 49 patients were classified into proximal, middle, and distal basilar artery occlusions. Twenty-two of these patients had additional vertebral artery lesions. A fourth group was composed of 36 patients with bilateral distal vertebral artery occlusion without opacification of the basilar artery through a vertebral artery injection. Onset was sudden in 20 patients; sudden, but preceded by prodromal symptoms in 11 patients; and progressive in 54 patients. Patients with progressive strokes often had bilateral vertebral artery occlusions. Most patients with acute onset had occlusion of the middle and distal basilar artery. An embolic origin of basilar artery occlusion from an arteriosclerotic vertebral artery lesion was assumed to be an important mechanism. An embolus reaching the basilar artery may not necessarily reach the top of the artery, but may also become lodged more proximally. (Stroke 1990;21:1135-1142) B asilar artery occlusions have been well recognized since Kubik and Adams 1 first suggested that this condition could be diagnosed during life. The disease had been known for many decades; however, it had only been recognized postmortem. The introduction of angiography for patients with posterior circulatory disease 2 was an important landmark in diagnosis. Nevertheless, because there was no effective treatment and prognosis was very poor, the effort toward accurate diagnosis was limited until recently.Since the advent of local intra-arterial fibrinolytic therapy by Zeumer et al, 3 -5 basilar artery thrombosis has become a potentially treatable disease, which, in turn, has provided a stimulus to improve noninvasive diagnostic methods such as Doppler ultrasound 6 and evoked potentials. -8 There have been many descriptions of clinical symptoms resulting from basilar artery occlusions, especially concerning the locked-in syndrome, which is an indicator of an advanced stage of the disease. However, there is still a lack of data concerning the premonitory spells and early clinical signs, which are still the first and most important diagnostic clues. Therefore, in this paper we focus on these early symptoms and signs and their correlation with angiographic findings, irrespective of the further Received September 22, 1989; accepted April 19, 1990. clinical course and the influence of therapy; the latter has been described previously. 9-10

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Section: -22contrasting

confidence: 48%

Clinical features of proven basilar artery occlusion.

Ferbert

Brückmann

Drummen

1990

Stroke

204

116

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“…[6,28] Symptomatic VB atherosclerotic occlusive disease can be associated with significant morbidity and mortality rates in up to 50% of patients. [3,24] Additionally, extra-and intracranial atherosclerotic disease is a significant predictor of extensive systemic disease and especially coronary artery disease. [15] Patients are at increased risk for myocardial infarction, sudden death, and stroke.…”

Section: Discussionmentioning

confidence: 99%

“…[3,24] Medical management includes both antiplatelet and anticoagulation therapies. However, in spite of maximum medical therapy, many patients exhibit refractory symptoms that necessitate revascularization procedures.…”

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confidence: 99%

Stent placement for vertebral artery occlusive disease: preliminary clinical experience

Fessler¹,

Wakhloo²,

Lanzino³

et al. 1998

FOC

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Symptoms of vertebrobasilar insufficiency may precede neurological sequelae in up to 50% of patients. Although select patients may benefit from microsurgical revascularization, combined perioperative morbidity and mortality rates can be as high as 20%. The authors present their preliminary clinical experience using stent placement for symptomatic vertebral artery (VA) occlusive disease. Six patients with clinical symptoms of vertebrobasilar insufficiency in whom VA stents were placed from 1995 to 1998 were identified. Diagnostic four-vessel cerebral angiography identified causative stenotic, atherosclerotic lesions in all cases. A transfemoral or transradial artery approach after the patient had undergone full heparinization was chosen for endovascular stenting. Guidewire placement across the lesion followed by urokinase infusion preceded stenting. Prestent angioplasty was performed in two patients. Following the procedure, all patients were maintained on daily antiplatelet therapy. Patient age ranged from 45 to 76 years (average 63 years). Four patients were men and two were women. Angiography revealed greater than 95% stenosis in five patients and greater than 70% stenosis in one. Three patients had complete occlusion of the contralateral VA; in one other, the VA supplied only the posterior inferior cerebellar artery; and the remaining two patients had VAs with greater than 70% stenosis. Ten stents were placed in six patients for five VA origin lesions and one distal VA stenosis. A VA dissection occurring poststenting was treated by placement of three additional stents. One patient had transient double vision. All had resolution of their presenting symptoms. Follow up ranged from 1 to 24 months (average 8.4 months). Angiograms obtained in four patients at least 3 months postprocedure have revealed stent patency in all cases without evidence of restenosis. Vertebral artery stent placement can be safely performed and is a viable treatment option for carefully selected patients with vertebrobasilar insufficiency.

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“…Twenty-three patients were an ticoagulated (38%; 95% Cl: 26-50; 16 men and 7 wom en, aged 73, range 37-96 years). Two patients had been Discussion Basilar artery thrombosis can be diagnosed during life with certainty only by angiography [2,4], Generally, however, angiography is not performed routinely, be cause most patients are old, have decreased conscious ness and severe neurological deficit, whereas in most of them angiographic findings will not influence clinical decisions, except in younger patients in whom various causes other than atherosclerosis should be considered [2], Angiographic studies performed for various reasons showed that occlusion of the basilar artery not always results in the classical clinical syndrome of decreased consciousness with bilateral long-tract signs and focal symptoms in the vertebrobasilar arterial territory' [5,9]. We diagnosed basilar artery thrombosis based on these clinical terms.…”

Section: Resultsmentioning

confidence: 99%

“…The clinical diagnosis of basilar artery thrombosis carries a bad prognosis [1][2][3][4][5]. The use of anticoagulants has been advocated mainly based on two early studies from the Mayo Clinic [6,7], However, these studies were small and retrospective, and so far no trial on the value of anticoagulation in basilar artery thrombosis has been done.…”

Section: Introductionmentioning

confidence: 99%

Presumed Basilar Artery Thrombosis and Anticoagulation

Merwijk¹,

Lodder²

1991

Cerebrovasc Dis

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We analyzed the outcome of 61 consecutive patients with presumed basilar artery thrombosis. Patients received anticoagulation unless a possibly favorable effect of such a treatment was not expected. Eight of 23 patients receiving anticoagulation died, against 30 of 38 patients not receiving this treatment (odds ratio 0.14; 95% CI: 0.04–0.47; p < 0.05). However, after adjusting for differences in age distribution and degree of initial deficit, no statistically significant difference remained. Our data do not argue in favor of or against anticoagulation treatment in patients with basilar artery thrombosis.

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Occlusion of the intradural vertebrobasilar artery

Cited by 47 publications

References 17 publications

Clinical features of proven basilar artery occlusion.

Clinical features of proven basilar artery occlusion.

Stent placement for vertebral artery occlusive disease: preliminary clinical experience

Presumed Basilar Artery Thrombosis and Anticoagulation

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