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Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis
  1. Edgar A Samaniego1,
  2. Amir Shaban2,
  3. Santiago Ortega-Gutierrez1,
  4. Jorge A Roa3,
  5. David M Hasan4,
  6. Colin Derdeyn5,
  7. Biyue Dai6,
  8. Harold Adams2,
  9. Enrique Leira2
  1. 1 Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2 Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  3. 3 Neurology and Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  4. 4 Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  5. 5 Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  6. 6 Biostatistics and Public Health, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Dr Edgar A Samaniego; edgar-samaniego{at}uiowa.edu

Abstract

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.

  • basilar artery stenosis
  • ischaemic stroke
  • transient ischemic attack
  • intracranial atherosclerotic disease
  • stroke mechanism
  • collateral circulation
  • posterior circulation

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors EAS, AS and EL: conception and design of the study. EAS, AS, JAR, BD: acquisition and analysis of data. EAS, JAR, EL: drafting of the manuscript/preparation of figures. SO-G, DMH, CD, HA: substantial scientific revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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