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Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis.

Publication ,  Journal Article
Samaniego, EA; Shaban, A; Ortega-Gutierrez, S; Roa, JA; Hasan, DM; Derdeyn, C; Dai, B; Adams, H; Leira, E
Published in: Stroke Vasc Neurol
December 2019

BACKGROUND: While diffuse atherosclerotic disease affecting the posterior circulation has been described extensively, the prevalence, natural history and angiographic characteristics of isolated symptomatic basilar artery stenosis (ISBAS) remain unknown. METHODS: We reviewed our prospective institutional database to identify patients with ≥50% symptomatic basilar artery (BA) stenosis without significant atherosclerotic burden in the vertebral or posterior cerebral arteries. Stroke mechanism, collateral circulation, and degree and length of stenosis were analysed. The primary outcome was time from index event to new transient ischaemic attack (TIA), acute ischaemic stroke (AIS) or death. Other outcome variables included modified Rankin Scale (mRS) score on discharge and last follow-up. RESULTS: Of 6369 patients with AIS/TIA, 91 (1.43%) had ISBAS. Seventy-three (80.2%) patients presented with AIS and 18 (19.8%) with TIA. Twenty-nine (31.9%) were women and the median age was 66.8±13.6 years. The mean follow-up time was 2.7 years. The most common stroke mechanism was artery-to-artery thromboembolism (45.2%), followed by perforator occlusion (28.7%) and flow-dependent/hypoperfusion (15.1%). The percentage of stenosis was lower in patients who had favourable outcome compared with those with mRS 3-6 on discharge (78.3±14.3 vs 86.9±14.5, p=0.007). Kaplan-Meier curves showed higher recurrence/death rates in patients with ≥80% stenosis, mid-basilar location and poor collateral circulation. Approximately 13% of patients with ISBAS presented with complete BA occlusion. CONCLUSION: ISBAS is an uncommon (1.43%) cause of TIA and AIS. Men in their 60s are mostly affected, and artery-to-artery embolism is the most common stroke mechanism. Mid-basilar location, ≥80% stenosis and poor collateral circulation are important factors associated with worse prognosis.

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Published In

Stroke Vasc Neurol

DOI

EISSN

2059-8696

Publication Date

December 2019

Volume

4

Issue

4

Start / End Page

189 / 197

Location

England

Related Subject Headings

  • Vertebrobasilar Insufficiency
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Recurrence
  • Recovery of Function
  • Middle Aged
  • Male
  • Ischemic Stroke
 

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Samaniego, E. A., Shaban, A., Ortega-Gutierrez, S., Roa, J. A., Hasan, D. M., Derdeyn, C., … Leira, E. (2019). Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis. Stroke Vasc Neurol, 4(4), 189–197. https://doi.org/10.1136/svn-2019-000246
Samaniego, Edgar A., Amir Shaban, Santiago Ortega-Gutierrez, Jorge A. Roa, David M. Hasan, Colin Derdeyn, Biyue Dai, Harold Adams, and Enrique Leira. “Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis.Stroke Vasc Neurol 4, no. 4 (December 2019): 189–97. https://doi.org/10.1136/svn-2019-000246.
Samaniego EA, Shaban A, Ortega-Gutierrez S, Roa JA, Hasan DM, Derdeyn C, et al. Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis. Stroke Vasc Neurol. 2019 Dec;4(4):189–97.
Samaniego, Edgar A., et al. “Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis.Stroke Vasc Neurol, vol. 4, no. 4, Dec. 2019, pp. 189–97. Pubmed, doi:10.1136/svn-2019-000246.
Samaniego EA, Shaban A, Ortega-Gutierrez S, Roa JA, Hasan DM, Derdeyn C, Dai B, Adams H, Leira E. Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis. Stroke Vasc Neurol. 2019 Dec;4(4):189–197.

Published In

Stroke Vasc Neurol

DOI

EISSN

2059-8696

Publication Date

December 2019

Volume

4

Issue

4

Start / End Page

189 / 197

Location

England

Related Subject Headings

  • Vertebrobasilar Insufficiency
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Recurrence
  • Recovery of Function
  • Middle Aged
  • Male
  • Ischemic Stroke