Journal List > J Korean Soc Radiol > v.77(6) > 1087874

Shin, Lee, Park, Lee, Kim, Kim, and Yi: Clinicoradiological Features and Outcomes of Patients with Atherosclerotic Basilar Artery Steno-Occlusion: A Single-Center Experience

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.

Conclusion

Atherosclerotic BA steno-occlusion disease is associated with a relative-ly low risk of a recurrent or new infarct and with favorable clinical outcomes following appropriate medical treatment.

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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.
jksr-77-388f1.tif
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.
jksr-77-388f2.tif
Table 1.
Clinicoradiological Characteristics of Patients with Basilar Artery Steno-Occlusion
Clinicoradiological Characteristics All (n = 92) p-Value
Infarct upon initial imaging, (%)
Yes 45 (48.9) < 0.001
No 47 (51.1)
Clinical presentation, (%)
Dizziness/dysarthria/diplopia 36 (39.1) 0.003
Extremity weakness 6 (6.5) 0.526
Top of basilar syndrome 1 (1.1) 0.585
No relevant symptoms 49 (53.3) 0.002
Lesion length, (%)
Short 70 (76.1) < 0.001
Long 22 (23.9)
Lesion location, (%)
Whole 14 (15.2) < 0.001
Distal 17 (18.5) 0.229
Proximal-middle 61 (66.3) < 0.001
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)*

* Numbers in parenthesis are number of new infarct/number of poor outcome.

Undetectable posterior communicating artery or co-existing vertebral artery steno-occlusion.

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

* Recent or chronic infarct on initial examination.

Recurrent or new infarct during follow-up, numbers in parenthesis are number of recurrent infarct/number of new infarct.

PCom = posterior communicating artery, VA = vertebral artery

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