title: Reflux of Anterior Spinal Artery Predicts Recurrent Posterior Circulation Stroke in Bilateral Vertebral Artery Disease.
abstract: OBJECTIVE
  Predictive value of reflux of anterior spinal artery for recurrent posterior circulation ischemia in bilateral vertebral arteries steno-occlusive disease was evaluated.
  
  
  METHODS
  We retrospectively reviewed 55 patients with symptomatic posterior circulation stroke caused by bilateral stenotic (>70%) lesions of the vertebral artery. We investigated any correlation of clinical and angiographic characteristics including collateral flow patterns, with recurrent stroke. Risk factors for poor 3-month functional outcome were also evaluated.
  
  
  RESULTS
  Recurrent posterior circulation stroke was observed in 15 (27.3%) patients. Multivariable analysis using Cox proportional hazards model showed anterior spinal artery reflux as a significant risk factor for stroke recurrence (adjusted hazard ratio, 19.3 [95% confidence interval, 5.35-69.9]; P<0.001). Anterior spinal artery reflux was also correlated with poor functional outcome (modified Rankin Scale score, 3-6; adjusted odds ratio, 7.41 [95% confidence interval, 1.24-44.4]; P=0.028).
  
  
  CONCLUSIONS
  In patients with symptomatic bilateral vertebral artery occlusive disease, anterior spinal artery reflux predicted recurrent posterior circulation stroke and poor functional outcome.
authors.affiliation: From the Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan (H.F., K.H., A.H., Y.K., S.Y.); and Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada (B.L.). fukudaharpseal@gmail.com.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fukuda
authors.affiliation: From the Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan (H.F., K.H., A.H., Y.K., S.Y.); and Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada (B.L.).
authors.forename: Kosuke
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: From the Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan (H.F., K.H., A.H., Y.K., S.Y.); and Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada (B.L.).
authors.forename: Akira
authors.initials: A
authors.lastname: Handa
authors.affiliation: From the Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan (H.F., K.H., A.H., Y.K., S.Y.); and Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada (B.L.).
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kurosaki
authors.affiliation: From the Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan (H.F., K.H., A.H., Y.K., S.Y.); and Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada (B.L.).
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lo
authors.affiliation: From the Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan (H.F., K.H., A.H., Y.K., S.Y.); and Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada (B.L.).
authors.forename: Sen
authors.initials: S
authors.lastname: Yamagata
mesh_terms: D000368:Aged; D001158:Arteries / Q000473:pathology / Q000503:physiopathology*; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000502:physiology*; D015331:Cohort Studies; D003097:Collateral Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013116:Spinal Cord / Q000098:blood supply*; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: atherosclerosis; ischemia; risk factors; stroke; vertebral artery