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Abstract
Purpose
There is a relatively higher risk of peri-procedural stroke following elective stenting of patients with basilar artery (BA) occlusion compared with stenting of in- tracranial arteries. We sought to diagnose stroke risks in patients with BA steno-oc-clusive disease by describing their clinicoradiological features and by demonstrating that appropriate treatment would lead to favorable outcomes.
Materials and Methods
A total of 92 patients who were treated from 2004 to 2016 for severe stenosis or occlusion of BA based on MR or CT angiography were en-rolled in the study. We assessed clinical features, radiologic findings, and other clinical outcomes such as the degree of disability as determined by the modified Rankin Scale.
Results
A total of 49 of the 92 patients (53.3%) had no relevant symptoms. The risk of a recurrent or new infarct in the relevant area was 4.59%/year. Following treat-ment, more than 50% of the 92 patients had favorable outcomes. A recurrent or new infarct was found in 9 (20.5%) of the 44 patients who had a poor prognosis. There was no significant difference between the two groups with respect to compromised circulation; however, the initial infarct (16 of 48 and 29 of 44, p = 0.002) was statis-tically significant between the two groups.
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Fig. 1.
Basilar artery stenosis due to atherosclerosis. An MR angiogram (A) shows a short stenosis at the middle basilar artery (short arrow). A proton density-weighted high-resolution MR image (B) shows eccentric wall thickening (arrow) at the middle basilar artery, which may be indic-ative of an atherosclerotic plaque. In an MR angiogram (A), the stenosis at the fourth segment of vertebral artery (long arrow), left is also noted.
Fig. 2.
Basilar artery occlusion. An CT angiogram reconstruction scan shows the entire length of the basilar artery occlusion (arrow), along with underlying vertebrobasilar hypoplasia.
Table 1.
Clinicoradiological Characteristics of Patients with Basilar Artery Steno-Occlusion
Table 2.
Comparison of New Infarct and Clinical Outcome between Symptomatic and Asymptomatic Patients with Atherosclerotic Basilar Artery Steno-Occlusion
| All (n = 92) | Symptomatic (n = 43) | Asymptomatic (n = 49) | p-Value | |
|---|---|---|---|---|
| Recurrent or new infarct, (%) | 11 (12.0) | 5 (11.6) | 6 (12.2) | 0.927 |
| Overall poor outcome, (%) | 22 (23.9) | 8 (18.6) | 14 (28.6) | 0.263 |
| Relevant poor outcome, (%) | 15 (16.3) | 8 (18.6) | 7 (14.3) | 0.576 |
| Inflow compromise† | ||||
| Yes | 61 (8/11)* | 27 (3/5)* | 34 (5/6)* | 0.504 |
| No | 31 (3/4)* | 16 (2/3)* | 15 (1/1)* |
Table 3.
Radiological Characteristics of Patients with Atherosclerotic Basilar Artery Steno-Occlusion with Poor and Favorable Outcomes
| Radiological Characteristics | All (n = 92) | Favorable Outcome (n = 48) | Poor Outcome | |||
|---|---|---|---|---|---|---|
| Overall (n = 44) | p-Value | p-Value | Relevant (n = 23) | |||
| Inflow compromise, (%) | ||||||
| Undetectable PCom | 35 (38.0) | 21 (43.8) | 14 (31.8) | 0.239 | 10 (43.5) | 0.535 |
| VA steno-occlusion | 45 (48.9) | 23 (47.9) | 22 (50.0) | 0.842 | 11 (47.8) | 0.904 |
| VA hypoplasia | 20 (21.7) | 8 (16.7) | 12 (27.3) | 0.218 | 3 (13.0) | 0.355 |
| Infarct*, (%) | 45 (48.9) | 16 (33.3) | 29 (65.9) | 0.002 | 17 (73.9) | 0.006 |
| Recurrent/new infarct†, (%) | 11 (7/4) (12.0) | 2 (0/2) (4.2) | 9 (7/2) (20.5) | 0.016 | 9 (7/2) (39.1) | < 0.001 |
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