INTRACRANIAL VERTEBRAL ARTERY DISEASE IN THE NEW-ENGLAND MEDICAL-CENTER POSTERIOR CIRCULATION REGISTRY

We studied 75 patients with severe intracranial vertebral artery (ICVA ) occlusive disease from the New England Medical Center Posterior Circ ulation Registry to learn the etiologies and locations of the vascular lesions, the location and patterns of related ischemia and infarction s, and the outcomes. All patients had neuroimaging and vascular studie s. Thirty-nine percent of patients had bilateral ICVA lesions. Twenty- four percent also had basilar artery disease and 36% had associated ex tracranial disease. The most common site of lesions was the distal ICV A after the origin of the posterior inferior cerebellar artery (PICA). Twenty-five percent of patients had only proximal intracranial poster ior-circulation territory infarcts (medullary and PICA cerebellar); 32 % had infarcts that involved other intracranial territories in additio n to the proximal territory. We found more distal intracranial territo ry infarcts resulting mainly from embolism from ICVA lesions than repo rted previously; this occurred in 17% of all patients. The ICVA was a recipient site for emboli in 8% of patients. Thirteen percent of patie nts died during follow-up. The outcome was favorable in most surviving patients. Three-fourths of them had no deficit or only slight disabil ity. The patients with distal territory infarcts due to emboli from th e ICVA had the worst outcome.