New England Medical Center Posterior Circulation registry.
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.
Caplan
Louis R
LR
Cerebrovascular Disease Sections of the New England Medical Center, Boston, MA, USA. lcaplan@bidmc.harvard.edu
Wityk
Robert J
RJ
Glass
Thomas A
TA
Tapia
Jorge
J
Pazdera
Ladislav
L
Chang
Hui-Meng
HM
Teal
Phillip
P
Dashe
John F
JF
Chaves
Claudia J
CJ
Breen
Joan C
JC
Vemmos
Kostas
K
Amarenco
Pierre
P
Tettenborn
Barbara
B
Leary
Megan
M
Estol
Conrad
C
Dewitt
L Dana
LD
Pessin
Michael S
MS
D000046:Academic Medical Centers; D000293:Adolescent; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D008297:Male; D009511:New England / Q000453:epidemiology; D012042:Registries; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology