New England Medical Center Posterior Circulation registry

Publication

New England Medical Center Posterior Circulation registry

Journal Paper/Review - Sep 10, 2004

Caplan Louis R, Dewitt L Dana, Estol Conrad, Leary Megan, Tettenborn Barbara, Amarenco Pierre, Vemmos Kostas, Breen Joan C, Chaves Claudia J, Dashe John F, Teal Phillip, Chang Hui-Meng, Pazdera Ladislav, Tapia Jorge, Glass Thomas A, Wityk Robert J, Pessin Michael S

Citation

Caplan L, Dewitt L, Estol C, Leary M, Tettenborn B, Amarenco P, Vemmos K, Breen J, Chaves C, Dashe J, Teal P, Chang H, Pazdera L, Tapia J, Glass T, Wityk R, Pessin M. New England Medical Center Posterior Circulation registry. Ann Neurol 2004; 56:389-98.

Type

Journal Paper/Review (English)

Journal

Ann Neurol 2004; 56

Publication Date

Sep 10, 2004

Issn Print

0364-5134

Pages

389-98

Brief description/objective

Among 407 New England Medical Center Posterior Circulation registry patients, 59% had strokes without transient ischemic attacks (TIAs), 24% had TIAs then strokes, and 16% had only TIAs. Embolism was the commonest stroke mechanism (40% of patients including 24% cardiac origin, 14% intraarterial, 2% cardiac and arterial sources). In 32% large artery occlusive lesions caused hemodynamic brain ischemia. Infarcts most often included the distal posterior circulation territory (rostral brainstem, superior cerebellum and occipital and temporal lobes); the proximal (medulla and posterior inferior cerebellum) and middle (pons and anterior inferior cerebellum) territories were equally involved. Severe occlusive lesions (>50% stenosis) involved more than one large artery in 148 patients; 134 had one artery site involved unilaterally or bilaterally. The commonest occlusive sites were: extracranial vertebral artery (52 patients, 15 bilateral) intracranial vertebral artery (40 patients, 12 bilateral), basilar artery (46 patients). Intraarterial embolism was the commonest mechanism of brain infarction in patients with vertebral artery occlusive disease. Thirty-day mortality was 3.6%. Embolic mechanism, distal territory location, and basilar artery occlusive disease carried the poorest prognosis. The best outcome was in patients who had multiple arterial occlusive sites; they had position-sensitive TIAs during months to years.