title: Vertebral artery ostium atherosclerotic plaque as a potential source of posterior circulation ischemic stroke: result from borgess medical center vertebral artery ostium stenting registry.
abstract: OBJECTIVE
  Although atherosclerotic plaque in the carotid and coronary arteries is accepted as a cause of ischemia, vertebral artery ostium (VAO) atherosclerotic plaque is not widely recognized as a source of ischemic stroke. We seek to demonstrate its implication in some posterior circulation ischemia.
  
  
  METHODS
  This is a nonrandomized, prospective, single-center registry on consecutive patients presenting with posterior circulation ischemia who underwent VAO stenting for significant atherosclerotic stenosis. Diagnostic evaluation and imaging studies determined the likelihood of this lesion as the symptom source (highly likely, probable, or highly unlikely). Patients were divided into 4 groups in decreasing order of severity of clinical presentation (ischemic stroke, TIA then stroke, TIA, asymptomatic), which were compared with the morphological and hemodynamic characteristics of the VAO plaque. Clinical follow-up 1 year after stenting assessed symptom recurrence.
  
  
  RESULTS
  One hundred fourteen patients underwent stenting of 127 lesions; 35% of the lesions were highly likely the source of symptoms, 53% were probable, and 12% were highly unlikely. Clinical presentation correlated directly with plaque irregularity and presence of clot at the VAO, as did bilateral lesions and presence of tandem lesions. Symptom recurrence at 1 year was 2%.
  
  
  CONCLUSIONS
  Thirty-five percent of the lesions were highly likely the source of the symptoms. A direct relationship between some morphological/hemodynamic characteristics and the severity of clinical presentation was also found. Finally, patients had a very low rate of symptom recurrence after treatment. These 3 observations point strongly to VAO plaque as a potential source of some posterior circulation stroke.
authors.affiliation: Neurosurgery of Kalamazoo, 1541 Gull Road, Suite 200, Kalamazoo, MI 49048, USA. firasalali@aol.com
authors.forename: Firas
authors.initials: F
authors.lastname: Al-Ali
authors.forename: Tom
authors.initials: T
authors.lastname: Barrow
authors.forename: Li
authors.initials: L
authors.lastname: Duan
authors.forename: Anne
authors.initials: A
authors.lastname: Jefferson
authors.forename: Susan
authors.initials: S
authors.lastname: Louis
authors.forename: Kim
authors.initials: K
authors.lastname: Luke
authors.forename: Kevin
authors.initials: K
authors.lastname: Major
authors.forename: Sandy
authors.initials: S
authors.lastname: Smoker
authors.forename: Sarah
authors.initials: S
authors.lastname: Walker
authors.forename: Margaret
authors.initials: M
authors.lastname: Yacobozzi
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000503:physiopathology*; D008297:Male; D012042:Registries; D020521:Stroke / Q000209:etiology / Q000503:physiopathology; D014711:Vertebral Artery / Q000503:physiopathology*; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000503:physiopathology