title: New England Medical Center Posterior Circulation registry.
abstract: 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.
authors.affiliation: Cerebrovascular Disease Sections of the New England Medical Center, Boston, MA, USA. lcaplan@bidmc.harvard.edu
authors.forename: Louis R
authors.initials: LR
authors.lastname: Caplan
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wityk
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Glass
authors.forename: Jorge
authors.initials: J
authors.lastname: Tapia
authors.forename: Ladislav
authors.initials: L
authors.lastname: Pazdera
authors.forename: Hui-Meng
authors.initials: HM
authors.lastname: Chang
authors.forename: Phillip
authors.initials: P
authors.lastname: Teal
authors.forename: John F
authors.initials: JF
authors.lastname: Dashe
authors.forename: Claudia J
authors.initials: CJ
authors.lastname: Chaves
authors.forename: Joan C
authors.initials: JC
authors.lastname: Breen
authors.forename: Kostas
authors.initials: K
authors.lastname: Vemmos
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
authors.forename: Barbara
authors.initials: B
authors.lastname: Tettenborn
authors.forename: Megan
authors.initials: M
authors.lastname: Leary
authors.forename: Conrad
authors.initials: C
authors.lastname: Estol
authors.forename: L Dana
authors.initials: LD
authors.lastname: Dewitt
authors.forename: Michael S
authors.initials: MS
authors.lastname: Pessin
mesh_terms: 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