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

Objective: To describe the clinical features of patients with occlusiv e disease of the proximal (V1) segment of the vertebral artery. Design and Patients: Patients with either occlusion or high-grade stenosis i nvolving the V1 segment were chosen for study from the New England Med ical Center Posterior Circulation Registry. The registry is a consecut ive series of patients with signs and symptoms of posterior circulatio n ischemia seen at the New England Medical Center, Boston, Mass, durin g a 10-year period. Clinical features, radiographic findings, and pati ent outcome were reviewed. Results: Of the 407 patients in the registr y, 80 (20%) had V1 segment lesions. Patients could be classified into 5 groups: (1) V1 disease and coexistent severe intracranial occlusive disease of the posterior circulation (n=22); (2) V1 disease with evide nce of artery-to-artery embolism (n=19); (3) suspected V1 disease with artery-to-artery embolism, but with other potential causes of stroke or less certain vascular diagnosis (n=20); (4) V1 disease associated w ith hemodynamic transient ischemic attacks (n=13); and (5) proximal ve rtebral arterial dissection (n=6). Hypertension, cigarette smoking, an d coronary artery disease were common risk factors. Clinical features, location of infarct, and outcome differed between groups and reflecte d the presumed mechanisms of stroke. Conclusions: Occlusive disease in volving the V1 segment of the vertebral artery is common in patients w ith posterior circulation ischemia, but is often associated with other potential mechanisms of stroke. However, in a series of patients seen at a tertiary referral center, occlusive disease of the V1 segment wa s the primary mechanism of ischemia in 9% of patients.