Lancet Neurol. Qureshi AI, Boulos AS, Hanel RA, et al. Cerebrovasc Dis. Occlusion of the basilar artery; a clinical and pathological study. There were no significant differences, however, between the 2 groups in the rates of ischemic stroke, MI, and sudden death combined (27.4/100 patient-years on aspirin versus 15.7/100 patient-years on warfarin; P=0.18) or in the rates of MI and sudden death combined (5.9/100 patient-years on aspirin versus 9.4/100 patient-years on warfarin; P=0.49). doi: 10.1093/brain/awp329. Patients enrolled in the WASID study22 were candidates for the current study. 8600 Rockville Pike Especially if these symptoms are permanent and prolonged, they become chronic and systematic. "what is the treatment and prognosis for someone with a combination of carotid occlusion/stenosis and occlusion/stenosis of the basilar artery?" Six patients had transient ischemic attacks (TIAs), and in two this was their only clinical manifestation. WASID was a retrospective, multicenter, nonrandomized study that compared the efficacy of warfarin versus aspirin for preventing stroke, MI, or sudden death in patients with symptomatic stenosis (50% to 99%) of a major intracranial artery (carotid siphon; anterior, middle, or posterior cerebral artery; vertebral artery; basilar artery; or posterior inferior cerebellar artery) .22. See AP, Pandey DK, Du X, Rose-Finnell L, Charbel FT, Derdeyn CP, Amin-Hanjani S; VERiTAS Study Group* †. Epub 2013 Feb 5. Dr Sila has received honoraria for lectures supported by DuPont Pharma and the Aspirin Foundation. Brain infarction most often affected the pons, but also frequently involved the cerebellum and thalamus. This site uses cookies. Acute and episodic vestibular syndromes caused by ischemic stroke: predilection sites and risk factors. The outcomes of patients with stroke in group 1 (35/43) was poor (severe disability or death) in 54% of cases. Financial support was received from the manufacturers of warfarin or aspirin by Dr Chimowitz, who gave grand rounds at the University of New Mexico in 1993, in the form of an honorarium provided by DuPont Pharma. November 01, 1987; 37 (11) Articles Middle and distal segments First published November 1, 1987, DOI: Abstract We report the clinical features and prognosis in nine patients with angiographically documented basilar artery stenosis of the middle and distal [n.neurology.org]. Occlusion and Stenosis of Basilar Artery. doi: 10.1161/JAHA.120.016406. Moreover, the stroke rates in patients with basilar artery or vertebral artery stenosis were higher than the rates of stroke reported in patients with symptomatic stenosis of the carotid siphon or MCA1112131415161718 and approached the stroke rates of patients with symptomatic extracranial carotid stenosis of ≥70%.23. National Library of Medicine Lancet Neurol. DuPont Pharma and Bayer have agreed to provide study medications for a planned clinical trial for which WASID is applying for NIH funding. Basilar artery stenosis: middle and distal segments. The TIAs in four patients included two or more of the following symptoms: dizziness, diplopia, perioral numbness, dysphagia, … Stroke in the territory of the stenotic artery was defined as a new infarct on CT or MRI in a region of the brain supplied by the symptomatic stenotic artery or (in the absence of an infarct on brain imaging) as the development of a new neurological deficit that lasted at least 24 hours and was localized to an area of the brain supplied by the symptomatic stenotic artery. 2020 May;19(5):413-421. doi: 10.1016/S1474-4422(20)30079-X. Unauthorized Patients were followed until occurrence of an end point, death from a nonvascular cause, change in antithrombotic therapy, or date of last contact. The location of the BAS and coexistent vertebral artery disease (defined as -~50% stenosis and calculated similarly to the BAS) was identified and correlated with the location of any brain infarction. All patients had previous transient ischemic attack or stroke in the territory of the stenotic artery and were treated with warfarin (n=42) or aspirin (n=26). Median age was 75 (53-83) years; median prethrombectomy National Institute of Health Stroke scale score was 19 … Acute occlusion of the basilar artery is a life threatening event, which carries a terrible prognosis: The TIAs in four patients included two or more of the following symptoms: dizziness, diplopia, perioral numbness, dysphagia, weakness, or loss of … Table 1. Stroke rates in the same territory as the stenotic artery (per 100 patient-years of follow-up) were 10.7 in patients with basilar artery stenosis, 7.8 in patients with vertebral artery stenosis, and 6.0 in patients with PCA or PICA stenosis. View Article PubMed/NCBI Google Scholar 9. Stroke rates in any vascular territory (per 100 patient-years of follow-up) were 15.0 in patients with basilar artery stenosis, 13.7 in patients with vertebral artery stenosis, and 6.0 in patients with PCA or PICA stenosis. organization. These patients were treated with an acute stenting of the basilar artery with or without a preceding mechanical thrombectomy. Wang Y, Ma Y, Gao P, Chen Y, Yang B, Feng Y, Jiao L. Front Neurol. Basilar artery occlusion is a potentially life-threatening subset of the larger category of posterior circulation strokes, carrying > 80% fatality rate without treatment. Shao JX, Ling YA, Du HP, Zhai GJ, Xu Y, Cao YJ. Columbia–Presbyterian Medical Center: D.E. As such, a recommendation regarding the use of warfarin for posterior circulation stenosis must await the results of a prospective randomized study. The percentage of patients who had a measured intracranial stenosis of 80% to 99% or an angiogram report indicating a severe intracranial stenosis was 55% (23 of 42) in the warfarin group and 50% (13 of 26) in the aspirin group. Privacy, Help The estimate of the normal arterial diameter at the point of maximum stenosis was taken as the closest measurable section of non-diseased vertebral artery (or basilar artery), i.e. Patients treated with aspirin had a significantly higher rate of ischemic stroke in any vascular territory compared with patients treated with warfarin (stroke rates per 100 patient-years of follow-up were 21.5 on aspirin versus 6.3 on warfarin; P=0.02). They are not providing financial support for the trial. Incidence of symptomatic vertebrobasilar stenosis in the general population. However, this retrospective study has several limitations, including a nonrandomized study design; the possibility that patients in this study may constitute a high-risk subgroup of patients with posterior circulation stenosis who were selected to undergo angiography; and the lack of standardized therapy, such as a uniform dose of aspirin and international normalized ratio target range. • 3. 2013 Oct;12(10):989-98. doi: 10.1016/S1474-4422(13)70211-4. For patients with atherosclerotic stenosis who survive basilar artery occlusion, the estimated annual risk of recurrent stroke is 20%. Acute basilar artery occlusion has a very high mortality rate. Such patients need close attention, since in the future the situation may worsen. Atherosclerotic stenosis of the major intracranial arteries is an important cause of ischemic stroke.12345678 In the United States, intracranial arterial stenosis causes approximately 10% of ischemic strokes,168910 ie, approximately 40 000 ischemic strokes annually. Risk factor profiles and angiographic findings of patients in the 2 treatment groups are shown in Table 2. The mean age was 62 years; 5 were treated with warfarin and 2 with aspirin or dipyridamole, and 2 were on no antithrombotic therapy. The basilar artery was divided into 3 equal segments (proximal, mid, and distal) to determine the site of maximal stenosis. Neurology. Interv Neuroradiol. All comparisons of event rates in the 2 treatment groups were 2 tailed and based on an intention-to-treat analysis. Results—During a median follow-up of 13.8 months, 15 patients (22%) had an ischemic stroke (4 fatal), 3 patients (4.5%) had a fatal myocardial infarction (MI) or sudden death, and 6 patients (9%) had a nonfatal MI. A complete list of the members of the WASID Study Group appears in the Appendix. Comparison of hemodynamic changes and prognosis between stenting and standardized medical treatment in patients with symptomatic moderate to severe vertebral artery origin stenosis. Presence of > or = 50% vertebral and basilar stenosis was unrelated to age, sex or vascular risk factors and, in contrast to > or = 50% carotid stenosis was not associated with evidence of coronary/peripheral atherosclerosis. Epub 2013 Apr 30. The higher risk of early recurrent stroke after posterior circulation transient ischaemic attack or minor stroke versus after carotid territory events could be due to a greater prevalence of large artery stenosis, but there have been few imaging studies, and the prognostic significance of such stenoses is uncertain. Prognosis of patients with symptomatic vertebral or basilar artery stenosis. We report the clinical features and prognosis in nine patients with angiographically documented basilar artery stenosis of the middle and distal segments. Qureshi AI, Boulos AS, Hanel RA, et al. Table 2. Basilar artery stenosis: middle and distal segments. The rates of primary end points (per 100 patient-years of follow-up) were 13.1 for ischemic stroke in any vascular territory (8.7 in the same territory as the stenotic artery, 4.4 in a different territory), 2.6 for fatal MI or sudden death, and 5.2 for nonfatal MI. Bethesda, MD 20894, Copyright Six of 8 strokes occurred in patients on a regimen of aspirin or dipyridamole, and 1 occurred in a patient on no antithrombotic therapy; treatment was not determined in the other patient who had a stroke. Sixty-eight patients with symptomatic stenosis (50% to 99%) of a major intracranial artery in the posterior circulation qualified for the current study. Basilar artery occlusion is a life-threatening vascular pathology that can initially present with relatively mild and nonspecific symptoms. Sixty-eight patients with symptomatic stenosis (50% to 99%) of a major intracranial artery in the posterior circulation qualified for the current study. Certain syndromes may have a good prognosis in terms of FOIA Moufarrij et al19 studied 44 patients (mean age, 57 years) with angiographically proved stenosis of ≥50% of the intracranial vertebral artery or basilar artery. G0500987/Medical Research Council/United Kingdom, OSRP2/1006/The Dunhill Medical Trust/United Kingdom, RP-PG-0606-1146/Department of Health/United Kingdom. RESULTS: Seven patients were identified who suffered from an acute basilar artery occlusion based on a high-grade stenosis between October 2009 and September 2013. The rates of both minor and major hemorrhagic complications were 11 per 100 patient-years of follow-up in the warfarin group compared with 0 per 100 patient-years of follow-up in the aspirin group (P<0.01). Follow-up was by chart review and personal or telephone interview. BACKGROUND: Acute brainstem infarction with basilar artery (BA) occlusive disease is the most fatal type of all ischaemic strokes. In the aspirin group, 21 of 26 (81%) were treated with at least 325 mg/d aspirin. Medicine (Baltimore). National Center METHODS: Consecutive patients who had acute brainstem infarction with at least 50% stenosis of BA upon CT angiography … Reliable data are necessary to determine the feasibility of trials of angioplasty and stenting and to inform imaging strategies. 1Includes 5 patients with bilateral intracranial vertebral artery stenosis. Hemorrhages were classified as major (fatal hemorrhage, any intracranial hemorrhage, bleeding requiring hospitalization, or bleeding requiring transfusion) or minor (any other bleeding complication). Dr Levine has received a research grant from DuPont Pharma. Tufts–New England Medical Center: S. Silliman, MS Pessin, L.R.Caplan. Levine. 1982 Nov. 32(11):1239-46. . Pulsinelli WA, Waldman S, Rawlinson D, Plum F. Moderate hyperglycemia augments ischemic brain damage: a neuropathologic study in the rat. Randomized comparison of intra-arterial and intravenous thrombolysis in a canine … DuPont Pharma supported two meetings of the WASID study group (both in 1996). The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Study Group. Three studies192021 of small series of patients suggest that the risk of stroke associated with intracranial vertebral artery, basilar artery, or PCA stenosis is 2.5% to 5.5% per year, which is substantially lower than the risk associated with carotid siphon or MCA stenosis. Secondary prevention trials showed that these agents are marginally better than aspirin alone; therefore, they may be the … Antiplatelet agents such as aspirin, clopidogrel, and the combination aspirin/dipyridamole (Aggrenox) can be used for stroke prophylaxis. Patients with basilar artery or vertebral artery stenoses (particularly bilateral vertebral artery stenosis) had the highest rate of stroke in this study (Table 1). Treatment consisted of aspirin or dipyridamole in 18 (41%), warfarin in 14 (32%), no antithrombotic therapy in 7 (16%), and undetermined treatment in 5 (11%). Mid-basilar location, ≥80% stenosis and poor collateral circulation are important factors associated with worse prognosis. Furlan, B. Dyko. 2015 Jun;14(6):606-14. doi: 10.1016/S1474-4422(15)00017-4. Compter A, Kappelle LJ, Algra A, van der Worp HB. Stroke. Treatment and prognosis Acute occlusion of the basilar artery is a life threatening event, which carries a terrible prognosis: ~90% mortality depending on the location, and high morbidity in the survivors 3. Epub 2020 Jun 20. CAD indicates coronary artery disease (angina, myocardial infarction, or coronary bypass surgery). Basilar artery stenosis: middle and distal segments. The proximal (13/28) and mid (10/28) basilar arteries were the most common sites of stenosis. We report the clinical features and prognosis in nine patients with angiographically documented basilar artery stenosis of the middle and distal segments. Cleveland Clinic Foundation: E. Weichel, C.A. Paclitaxel Coated Balloon vs. Bare Metal Stent for Endovascular Treatment of Symptomatic Vertebral Artery Origin Stenosis Patients: Protocol for a Randomized Controlled Trial. 2013 Mar;44(3):598-604. doi: 10.1161/STROKEAHA.112.669929. Patients with acute basilar artery occlusion have a mortality rate of greater than 85%, although the mortality rate may be as low as 40% in patients with recanalization. Some of the common symptoms of a basilar artery stroke include the following: 1. While there are numerous studies on the risk of stroke in patients with carotid siphon or MCA stenosis, there are limited data on the prognosis of patients with angiographically proved stenosis of the intracranial vertebral arteries, basilar artery, or PCAs. Even with modern local intraarterial fibrinolytic treatment, death is still a probable outcome for these patients (7–9). During a mean follow-up of 6.1 years, 8 patients (18%) had a stroke (3 fatal; 5 of the 8 strokes were in the territory of the stenotic artery) and 5 patients (11%) died from causes unrelated to stroke (2 cardiac). Background and Purpose—There are limited data on the prognosis of patients with angiographically proved symptomatic stenosis of the intracranial vertebral artery or basilar artery. doi: 10.1097/MD.0000000000014899. We report the clinical features and prognosis in nine patients with angiographically documented basilar artery stenosis of the middle and distal segments. Sudden death was defined as death of sudden onset that could not be explained by a known nonvascular process. Hurford R, Wolters FJ, Li L, Lau KK, Küker W, Rothwell PM; Oxford Vascular Study Phenotyped Cohort. Stenting versus medical treatment in patients with symptomatic vertebral artery stenosis: a randomised open-label phase 2 trial. During follow-up, 1 patient (11%) taking warfarin had a fatal brain stem stroke and 2 patients died (1 of the original stroke and 1 of alcohol abuse). Since the basilar artery supplies blood to the body of the body - the brain, the pain can not be ignored. In patients with posterior circulation events, > or = 50% vertebral and basilar stenosis was associated multiple transient ischaemic attacks at presentation (22% versus 3%; OR = 9.29; 95% CI = 2.31-37.27; P < 0.001) and with a significantly higher 90-day risk of recurrent events (OR = 3.2; 95% CI = 1.4-7.0; P = 0.006), reaching 22% for stroke and 46% for transient ischaemic attack and stroke. Potential candidates for WASID were identified by reviewing the reports of consecutive angiograms performed at 7 participating centers between 1985 and 1991. The American Heart Association is qualified 501(c)(3) tax-exempt Exclusion criteria were occlusion of an intracranial artery; nonatherosclerotic intracranial vasculopathies, such as dissection, moyamoya disease, or vasculitis; asymptomatic stenosis of a major intracranial artery; distal branch stenosis of an intracranial artery; coexistent cardioembolic source (ie, atrial fibrillation, mitral stenosis, prosthetic valve, MI within 6 weeks, intracardiac clot, ventricular aneurysm, or bacterial endocarditis); a severe neurological deficit from the qualifying stroke or from a stroke occurring during cerebral angiography; stroke prevention treatment other than aspirin or warfarin (eg, angioplasty, warfarin and aspirin concurrently, ticloplidine, or dipyridamole alone); and absence of follow-up data (ie, no notes on the chart after angiography and no patient contact). Tong D, Chen X, Wang Y, Wang Y, Du L, Bao J. J Int Med Res. 1982 Nov. 32(11):1239-46. . The rate of stroke in the same territory as the stenotic artery in patients on aspirin (per 100 patient-years) was 11.7 (9.6 in patients with 50% to 79% stenosis versus 15.1 in patients with 80% to 99% stenosis). This will depend on the extent of disease; however: 1. Additionally, the mean age of patients and mean percent stenosis of the symptomatic intracranial artery in both treatment groups were similar (Table 2). Lancet Neurol. This process is known as atherosclerosis. In 1 patient, angioplasty of a basilar artery stenosis was performed following thrombolysis. Vertebrobasilar insufficiency (VBI) describes a temporary set of symptoms due to decreased blood flow in the posterior circulation of the brain.The posterior circulation supplies the medulla, pons, midbrain, cerebellum and (in 70-80% of people) supplies the posterior cerebellar artery to the thalamus and occipital cortex. At the initial stages of thrombosis of the basilar artery, there may be a short-term loss of hearing, which is combined with noise in the ears. The narrowing is caused by a buildup and hardening of fatty deposits called plaque. 1998; 29(7):1389-92 (ISSN: 0039-2499) BACKGROUND AND PURPOSE: There are limited data on the prognosis of patients with angiographically proved symptomatic stenosis of the intracranial vertebral artery or basilar artery. The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Study Group. This finding suggests that symptomatic vertebrobasilar stenosis behaves similarly to symptomatic extracranial carotid artery stenosis, which is associated with a higher risk of ipsilateral stroke for each decile increase in percent stenosis above 70%.23 The high rate of stroke in the territory of a severely stenotic vertebral or basilar artery with either antithrombotic agent suggests that adjunctive stroke-preventive therapies (eg, intracranial angioplasty24–26) may be needed for patients with symptomatic high-grade vertebral or basilar artery stenosis. Despite the higher frequency of basilar artery or bilateral vertebral artery stenoses in the warfarin group (57% of patients) compared with the aspirin group (35% of patients), patients treated with warfarin had a significantly lower rate of ischemic stroke than patients treated with aspirin. On the extent of disease ; however: 1 basilar arteries were most... 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