J Clin Neurol.  2005 Apr;1(1):31-49. 10.3988/jcn.2005.1.1.31.

New England Medical Center Posterior Circulation Stroke Registry II. Vascular Lesions

Affiliations
  • 1Cerebrovascular Disease Sections of the New England Medical Center, Boston and the Beth Israel Deaconess Medical Center, Boston. lcaplan@bidmc.harvard.edu

Abstract

Among 407 New England Medical Center Posterior Circulation Registry (NEMC-PCR) patients, the extracranial (ECVA) and intracranial vertebral arteries (ICVA) were the commonest sites of severe occlusive disease followed by the basilar artery (BA). Severe occlusive lesions were found in >1 large artery in 148 patients; 134 had unilateral or bilateral severe disease at one arterial location. Single arterial site occlusive disease occurred most often in the ECVA (52 patients, 15 bilateral) followed by the ICVA (40 patients, 12 bilateral) and the BA (46 patients). Involvement of the ICVAs and the BA was very common and some patients also had ECVA lesions. Hypertension, smoking, and coronary and peripheral vascular disease were most prevalent in patients with extracranial disease while diabetes and hyperlipidemia were more common when occlusive lesions were only intracranial. Intra-arterial embolism was the most common mechanism of brain infarction in patients with ECVA and ICVA occlusive disease. ICVA occlusive lesions infrequently caused infarction limited to the proximal territory (medulla and posterior inferior cerebellum). BA lesions most often caused infarcts limited to the middle posterior circulation territory (pons and anterior inferior cerebellum). Posterior cerebral artery occlusive lesions were predominantly embolic. Penetrating artery disease caused mostly pontine and thalamic infarcts. Prognosis was poorest in patients with BA disease. The best prognosis surprisingly was in patients who had multiple arterial occlusive lesions; they often had position-sensitive transient ischemic attacks during months or years.

Keyword

Brain ischemia; Brain embolism; Posterior circulation; Vertebral arteries; Basilar artery; Posterior cerebral arteries; Brainstem; Cerebellum

MeSH Terms

Arteries
Basilar Artery
Brain Infarction
Brain Ischemia
Brain Stem
Cerebellum
Embolism
Humans
Hyperlipidemias
Hypertension
Infarction
Intracranial Embolism
Ischemic Attack, Transient
New England*
Peripheral Vascular Diseases
Posterior Cerebral Artery
Prognosis
Smoke
Smoking
Stroke*
Vertebral Artery
Smoke

Figure

  • Figure 1 The distribution of intracranial posterior circulation infarcts in patients with proximal vertebral artery occlusive disease. ECVA; extracranial vertebral artery

  • Figure 2 The distribution of intracranial posterior circulation infarcts in patients with intracranial vertebral artery occlusive disease. ICVA; intracranial vertebral artery

  • Figure 3 The distribution of intracranial posterior circulation infarcts in patients with Basilar artery occlusive disease. BA; basilar artery

  • Figure 4 The distribution of intracranial posterior circulation infarcts in patients with penetrating artery occlusive disease.


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