COMPARISON OF PERIPROCEDURAL COMPLICATIONS AND LONG-TERM OUTCOME OF INTRACRANIAL ANGIOPLASTY ALONE OR WITH STENTING OF PERFORATOR-BEARING ARTERIES IN THE ANTERIOR AND POSTERIOR CIRCULATION

The aim of the work is to examine the features of recovery of lost neurological functions and the quali ty of life of patients with acute vertebrobasilar infarction, to evaluate and compare the short-term and long-term outcome of a stroke depending on the aff ected intracranial anatomical areas of the posterior circulation basin. 120 patients with acute vertebrobasilar infarction were examined, among them 22 (18.3 %) patients had a cerebral infarction, 38 (31.7 %) — pontine infarction, 13 (10.8 %) — midbrain infarction, 22 (18.3 %) — thalamic infarction and 25 (20.8 %) patients — cerebellar infarction. Strokes were distributed into three intracranial anatomical territories of the posterior circular basin: proximal, medial, distal. The diagnosis was established on the basis of data from the neurological clinic and magnetic resonance imaging in standard and DV modes. Clinical and neurological comparisons and a comparative statistical analysis of the functional outcomes of infarctions on the 21st and 90th day of a prospective observation. Despite the fact that there is no clear functional boundary between the proximal, medial and distal intracranial anatomical territories of the posterior circulation basin, which once again confi rms their functional unity, the potential for resuming lost neurological functions, a short-term and long-term outcome after infarction of diff erent anatomical and topographic areas of posterior circulation basin do not always match. Statistical analysis pointed that the short-term and long-term functional outcome after a infarction in diff erent intracranial vascular territories of the posterior circulation basin had certain features of the evolution of functional and neurological recovery. In particular, cerebellar infarctions had a signifi cantly better functional outcome compared to infarctions of the medulla oblongata in the short and long term perspective and midbrain infarctions — on the 90th day of the prospective observation (p <0.05). Paired comparisons of functional consequences between cere bellar, pontine and thalamic infarction did not reveal a statistically signifi cant (p > 0.05) correlation between factorial and eff ective signs during short-term and longterm follow-up.

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Posterior circulation perforator aneurysms: a proposed management algorithm

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012891 ◽

2017 ◽

Vol 10 (1) ◽

pp. 55-59 ◽

Cited By ~ 6

Author(s):

Thomas J Buell ◽

Dale Ding ◽

Daniel M S Raper ◽

Ching-Jen Chen ◽

Harry R Hixson ◽

...

Keyword(s):

Outcome Data ◽

Posterior Circulation ◽

Thrombotic Complication ◽

Term Outcome ◽

Long Term Outcome ◽

Antifibrinolytic Therapy ◽

Management Algorithm ◽

Initial Imaging

IntroductionSubarachnoid hemorrhage (SAH) from posterior circulation perforator aneurysms (PCPAs) is rare and its natural history is unknown. Diagnosis may be difficult, acute management is poorly defined, and long-term recurrent SAH rates and clinical outcome data are lacking.MethodsWe searched our institution's records for cases of PCPA rupture and analyzed patient demographics, Hunt and Hess (HH) grades, diagnostic imaging, management, and clinical outcomes. We conducted telephone interviews to calculate modified Rankin Scale (mRS) scores.ResultsWe identified 9 patients (6 male, 3 female) with a ruptured PCPA who presented to the University of Virginia Health System (Charlottesville, VA, USA) between 2010 and 2016. Median and mean ages were 62 and 63 years, respectively. Median HH grade was 3. Seven of nine (78%) PCPAs were angiographically occult on initial imaging and median time to diagnosis was 5 days. Three conservatively managed patients had a mean mRS score of 0.67 (range 0–1) at mean follow-up of 35.3 months. Antifibrinolytic therapy was administered to all conservatively managed patients without thrombotic complication. Six patients receiving endovascular treatment had a mean mRS score of 2.67 (range 0–6) at mean follow-up of 49.2 months. No cases of recurrent SAH were seen in the study.ConclusionsThe rarity of PCPA has precluded long-term clinical follow-up until now. Our experience suggests low recurrent SAH rates. Until further studies are performed, conservative management, possibly combined with antifibrinolytic therapy, may be a viable treatment with acceptable long-term outcome.

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Abstract WP142: Low Risk Of Posterior Circulation Stroke In Ischemic Stroke Patients With Vertebral Artery Ositium Stenosis

Stroke ◽

10.1161/str.44.suppl_1.awp142 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Seung Hoon Song ◽

Joon Hwa Lee ◽

So Young Moon ◽

Hahn Young Kim

Keyword(s):

Ischemic Stroke ◽

Vertebral Artery ◽

Acute Ischemic Stroke ◽

Recurrent Stroke ◽

Posterior Circulation ◽

Stroke Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Angioplasty And Stenting

Backgrounds Atherosclerosis of vertebrobasilar artery is a major cause of the ischemic stroke in the posterior circulation. Vertebral artery ostium stenosis (VAOS) is occasionally observed in patients with acute ischemic stroke in anterior or posterior circulation. However, VAOS as a risk for stroke recurrence, especially for the posterior circulation stroke, has not been well studied. This study was performed to determine long-term outcome and clinical significance of VAOS in acute ischemic stroke patients. Methods As a prospective observational study of single stroke center registry, we studied risk of recurrent stroke and vascular outcome in acute ischemic stroke patients with VAOS, recruited consecutively from December 2007 to December 2010. VAOS was defined as more than 50% stenosis of either vertebral artery ostium on a contrast-enhanced MRA. Vascular risk factors and long-term outcome including recurrent stroke, cardiovascular event, vascular mortality, or all-cause mortality were investigated. Results Of 773 acute ischemic stroke patients, underwent contrast-enhanced MRA, 149 (19.2%) had more than 50% VAOS (age, 70±10 years). All patients had intensive medical treatment and 11 patients underwent angioplasty and stenting. During 327 patient-years of follow-up (mean, 2.2 years), there were 8 ischemic (3 in posterior circulation, 5 in anterior circulation), 5 hemorrhagic, and 2 unknown stroke. The annual rate of events were 1.36% for posterior circulation ischemic stroke, 3.64% for all ischemic stroke, 5.91% for all stroke, 1.36% for vascular death, and 9.55% for all cause mortality. Symptomatic VAOS, concomitant stenosis of other vertebrobasilar arteries or carotid arteries, or stroke subtype was not associated with long-term outcome. Conclusions Long-term outcome of acute ischemic stroke patients with more than 50% VAOS was favorable on intensive medical treatment and selective angioplasty and stenting. Vertebral artery ostium stenosis may not be a major risk factor for the recurrent ischemic stroke in the posterior circulation.

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Petrosal approaches to posterior circulation aneurysms

Neurosurgical FOCUS ◽

10.3171/2012.6.focus12131 ◽

2012 ◽

Vol 33 (2) ◽

pp. E9 ◽

Cited By ~ 10

Author(s):

Bradley A. Gross ◽

Daryoush Tavanaiepour ◽

Rose Du ◽

Ossama Al-Mefty ◽

Ian F. Dunn

Keyword(s):

Natural History ◽

Posterior Circulation ◽

Term Outcome ◽

Long Term Outcome ◽

Posterior Circulation Aneurysms ◽

Aneurysm Occlusion

Complex posterior circulation aneurysms are formidable lesions with an abysmal natural history. Their management continues to present a challenge to both endovascular and open microsurgical approaches. Affording an expansive, combined supra- and infratentorial exposure, the petrosal approaches are well suited for these challenging lesions when located along the basilar trunk or at a low-lying basilar apex. This report evaluates the evolution and application of petrosal approaches to these lesions. Excluding transsigmoid, infratentorial, or labyrinth-sacrificing approaches, the authors found 23 reports with 61 posterior circulation aneurysms treated via a petrosal approach. Although early morbidity was not negligible, rates of aneurysm occlusion (95% overall) and long-term outcome were quite laudable in light of the challenge posed by these lesions. Moreover, with accumulating experience with petrosal approaches, rates of complications are likely to wane, as neurosurgeons capitalize on the expansive exposure afforded by these indispensable approaches.

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Endovascular treatment of patients with high-risk symptomatic intracranial vertebrobasilar stenoses: long - term outcomes

Stroke and Vascular Neurology ◽

10.1136/svn-2019-000230 ◽

2019 ◽

Vol 4 (4) ◽

pp. 182-188

Author(s):

Tanja Djurdjevic ◽

André Cunha ◽

Ursula Schulz ◽

Dennis Briley ◽

Peter Rothwell ◽

...

Keyword(s):

High Risk ◽

Endovascular Treatment ◽

Vertebral Artery ◽

Posterior Circulation ◽

Term Outcome ◽

Long Term Outcome ◽

Long Term Follow Up ◽

Recurrent Strokes

Background and purposeWe present the long-term outcome after endovascular treatment of symptomatic intracranial posterior circulation stenoses.Methods30 patients with symptomatic intracranial posterior circulation stenoses exceeding 70% underwent endovascular treatment between 2006 and 2012. Data regarding presentation, follow-up, procedure details, complications and imaging follow-up were reviewed. All surviving patients underwent a phone interview to establish their current Modified Ranking Scales (MRS).ResultsStenoses of the intracranial vertebral artery (24 patients) and basilar artery (6 patients) were treated with stents (10 patients), angioplasty alone (13 patients) or both (5 patients). Two procedures failed. One patient (3.3%) died after the procedure, two had stroke (6.6%) and one a subarachnoid haemorrhage without ensuing deficit. Two patients (6.7%) had asymptomatic complications (dissection and pseudoaneurysm). The median clinical follow-up time was 7 years. Of the 29 patients who survived the procedure, 6 died due to unrelated causes. Three patients (10%) had recurrent strokes and two (6.7%) a transient ischaemic attack in the posterior circulation. Two patients had subsequent middle cerebral artery strokes. Five (16.7%) patients had recurrent stenoses and three (10%) occlusions of the treated artery. Retreatment was performed in six patients, three (10%) with PTA and three (10%) with stenting. Current MRS scores were as follows: nine MRS 0, eight MRS 1, four MRS 2 and one MRS 4.ConclusionsLong-term follow-up after endovascular treatment of high-risk symptomatic intracranial posterior circulation stenoses shows few stroke recurrences. Treatment of intracranial vertebral artery stenosis may be beneficial in appropriately selected patients.

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Surgical and endovascular management of symptomatic posterior circulation fusiform aneurysms

Journal of Neurosurgery ◽

10.3171/jns.2007.106.5.855 ◽

2007 ◽

Vol 106 (5) ◽

pp. 855-865 ◽

Cited By ~ 67

Author(s):

Bert A. Coert ◽

Steven D. Chang ◽

Huy M. Do ◽

Michael P. Marks ◽

Gary K. Steinberg

Keyword(s):

Medical Center ◽

Mass Effect ◽

Posterior Circulation ◽

Consecutive Series ◽

Term Outcome ◽

Long Term Outcome ◽

Female Ratio ◽

Poor Outcome ◽

Aneurysm Thrombosis

Object Patients with fusiform aneurysms can present with subarachnoid hemorrhage (SAH), mass effect, ischemia, or unrelated symptoms. The absence of an aneurysm neck impedes the direct application of a clip and endovascular coil deployment. To evaluate the effects of their treatments, the authors retrospectively analyzed a consecutive series of patients with posterior circulation fusiform aneurysms treated at Stanford University Medical Center between 1991 and 2005. Methods Forty-nine patients (mean age 53 years, male/female ratio 1.2:1) treated at the authors' medical center form the basis of the analysis. Twenty-nine patients presented with an SAH. The patients presenting without SAH had cranial nerve dysfunction (five patients), symptoms of mass effect (eight patients), ischemia (six patients), or unrelated symptoms (one patient). The aneurysms were located on the vertebral artery (VA) or posterior inferior cerebellar artery (PICA) (21 patients); vertebrobasilar junction (VBJ) or basilar artery (BA) (18 patients); and posterior cerebral artery (PCA) (10 patients). Pretreatment clinical grades were determined using the Hunt and Hess scale; for patients with un-ruptured aneurysms (Hunt and Hess Grade 0) functional subgrades were added. Outcome was evaluated using the Glasgow Outcome Scale (GOS) score during a mean follow-up period of 33 months. Overall long-term outcome was good (GOS Score 4 or 5) in 59%, poor (GOS Score 2 or 3) in 16%, and fatal (GOS Score 1) in 24% of the patients. In a univariate analysis, poor outcome was predicted by age greater than 55 years, VBJ location, pretreatment Hunt and Hess grade in patients presenting with SAH, and incomplete aneurysm thrombosis after endovascular treatment. In a multivariate analysis, age greater than 55 years was the confounding factor predicting poor outcome. Stratification by aneurysm location removed the effect of age. Of 13 patients with residual aneurysm after treatment, five (38%) subsequently died of SAH (three patients) or progressive mass effect/brainstem ischemia (two patients). Conclusions Certain posterior circulation aneurysm locations (PCA, VA–PICA, and BA–VBJ) represent separate disease entities affecting patients at different ages with distinct patterns of presentation, treatment options, and outcomes. Favorable overall long-term outcome can be achieved in 90% of patients with PCA aneurysms, in 60% of those with VA–PICA aneurysms, and in 39% of those with BA–VBJ aneurysms when using endovascular and surgical techniques. The natural history of the disease was poor in patients with incomplete aneurysm thrombosis after treatment.

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