The Intracranial Vertebral Artery: A Neglected Species

Caplan, Louis R.

doi:10.1159/000339629

Cited by 36 publications

(36 citation statements)

References 61 publications

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“…This is supported by findings from the New England Medical Center Posterior Circulation Registry, where almost half of the patients with a posterior circulation stroke had episodes of dizziness (with or without vertigo), and 5% of the patients had loss of consciousness [9]. More than half of the patients with an accompanying unilateral VA stenosis had complaints of lightheadedness [10]. Comparable frequencies were found in our study, where 71% of the patients with a posterior circulation event had nonrotatory dizziness or vertigo and 7% had loss of consciousness.…”

Section: Discussionmentioning

confidence: 88%

Nonfocal Symptoms are More Frequent in Patients with Vertebral Artery than Carotid Artery Stenosis

et al. 2013

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Introduction: In patients with a transient ischemic attack (TIA) or ischemic stroke, the combination of focal and nonfocal symptoms has been associated with a higher risk of cardiovascular events. We hypothesized that nonfocal symptoms are more frequent in patients with symptomatic stenosis of a vertebral artery (VA) than of a carotid artery (CA). Therefore, we assessed the prevalence of nonfocal symptoms in patients with a recent TIA or nondisabling ischemic stroke and studied their relation with symptomatic CA or VA stenosis. Methods: We administered a standardized questionnaire on the occurrence of focal and nonfocal symptoms during the qualifying TIA or nondisabling ischemic stroke and in the preceding 6 months. We included 50 consecutive patients with a recently symptomatic CA stenosis ≥50%, 50 consecutive patients with a recently symptomatic VA stenosis ≥50%, 25 consecutive patients with an anterior circulation event without an ipsilateral CA stenosis ≥50%, and 25 consecutive patients with a posterior circulation event without a relevant VA stenosis ≥50%. Relative risks for the presence of nonfocal symptoms in relation to the presence of a symptomatic stenosis were calculated with univariate and multivariate Poisson regression. Adjustments were made for age, sex, stroke as the qualifying event, and cardiovascular risk factors. A subgroup analysis was performed for patients in whom the vascular territory of the event was confirmed on imaging. Results: During the qualifying ischemic event, focal symptoms were accompanied by nonfocal symptoms in 80 (53%) patients. Nonfocal symptoms occurred more frequently in patients with a VA stenosis (72%) than in patients with a CA stenosis [26%; adjusted relative risk (aRR), 2.9; 95% confidence interval (CI), 1.8-4.6]. A higher prevalence of nonfocal symptoms was found in patients with posterior circulation TIAs and strokes (73%) than in patients with anterior circulation TIAs and strokes (33%; aRR, 2.2; 95% CI, 1.6-3.1). During the preceding 6 months, 45% of patients with and 20% of patients without a symptomatic stenosis had had nonfocal symptoms (aRR, 2.4; 95% CI, 1.3-4.3). Subgroup analysis for the 89 (59%) patients with ischemia visible on imaging gave essentially the same results. Conclusions: More than half of the TIAs or nondisabling ischemic strokes were associated with nonfocal neurological symptoms. Nonfocal symptoms occurred more frequently in patients with a symptomatic VA stenosis than CA stenosis.

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Section: Discussionmentioning

confidence: 88%

Nonfocal Symptoms are More Frequent in Patients with Vertebral Artery than Carotid Artery Stenosis

et al. 2013

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“…Severe intracranial vertebral artery stenosis (IVAS) or occlusion is the most common arterial lesion causing posterior circulation ischemia (Caplan 2012). The rate of recurrent stroke in patients with symptomatic intra-cranial atherosclerotic stenosis has been higher than 10% per year, despite aggressive medical treatment (Chimowitz et al 2005;Derdeyn et al 2014).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Interventional Therapy for Patients with Intracranial Vertebral Artery Stenosis by Transcranial Color-Coded Sonography

Zhou

Yang

et al. 2016

Ultrasound in Medicine & Biology

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“…Intracranial vertebral artery (ICVA) is a common site of atherosclerosis, often involved bilaterally [1, 2]. Patients with bilateral ICVA occlusion usually present with recurrent attacks of dizziness, visual disturbance, and ataxia, and some may be disabled by infarction of regions supplied by the posterior circulation [2].…”

Section: Introductionmentioning

confidence: 99%

Endovascular Recanalization for Chronic Symptomatic Intracranial Vertebral Artery Total Occlusion

et al. 2014

Minimally Invasive Surgery

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Purpose. The outcome of recanalization in patients with chronic symptomatic intracranial vertebral artery (ICVA) total occlusion is poor. This paper reports the technical feasibility and long-term outcome of ICVA stenting in patients with chronic symptomatic total occlusion. Methods. Retrospective review of our prospectively maintained intracranial intervention database to identify patients with symptomatic total occlusion of ICVA with revascularization attempted >1 month after index ischemic event. Results. Eight patients (mean age 58 years) were identified. One had stroke and 7 had recurrent transient ischemic attacks. Four had bilateral ICVA total occlusion and 4 had unilateral ICVA total occlusion with severe stenosis contralaterally. Seven of 8 patients underwent endovascular recanalization, which was achieved in 6. Periprocedural complications included cerebellum hemorrhage, arterial dissection, perforation, and subacute in-stent thrombosis which occurred in 3 patients. One patient died of cerebellum hemorrhage. The other patients improved clinically after endovascular therapy. Conclusions. Stent-supported recanalization of ICVA total occlusion is technically feasible, and may become a viable treatment option in selected patients.

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The Intracranial Vertebral Artery: A Neglected Species

Cited by 36 publications

References 61 publications

Nonfocal Symptoms are More Frequent in Patients with Vertebral Artery than Carotid Artery Stenosis

Nonfocal Symptoms are More Frequent in Patients with Vertebral Artery than Carotid Artery Stenosis

Evaluation of Interventional Therapy for Patients with Intracranial Vertebral Artery Stenosis by Transcranial Color-Coded Sonography

Endovascular Recanalization for Chronic Symptomatic Intracranial Vertebral Artery Total Occlusion

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