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Correspondence to Marc I. Chimowitz MB, ChB, Department of Neurology, Emory University, 4th Floor Emory Clinic, 1365 Clifton Rd, Atlanta GA 30322. E-mail mchimo{at}neuro.emory.edu
Background and Purpose—There are
limited data on the prognosis of patients with angiographically proved
symptomatic stenosis of the intracranial vertebral
artery or basilar artery.
Methods—We studied 68 patients with 50% to 99% stenosis
of one of the following arteries: intracranial vertebral (n=31),
basilar (n=28), posterior cerebral (PCA) (n=6), or posterior
inferior cerebellar (PICA) (n=3). All patients had previous
transient ischemic attack or stroke in the territory of the
stenotic artery and were treated with warfarin (n=42) or
aspirin (n=26). Follow-up was by chart review and personal or telephone
interview.
Results—During a median follow-up of 13.8 months, 15 patients
(22%) had an ischemic stroke (4 fatal), 3 patients (4.5%) had
a fatal myocardial infarction (MI) or sudden death, and 6 patients
(9%) had a nonfatal MI. Stroke rates in any vascular territory (per
100 patient-years of follow-up) were 15.0 in patients with basilar
artery stenosis, 13.7 in patients with vertebral artery
stenosis, and 6.0 in patients with PCA or PICA
stenosis. Stroke rates in the same territory as the
stenotic artery (per 100 patient-years of follow-up) were 10.7
in patients with basilar artery stenosis, 7.8 in patients with
vertebral artery stenosis, and 6.0 in patients with PCA or PICA
stenosis.
Conclusions—Patients with symptomatic intracranial
vertebral artery or basilar stenosis are at high risk of
stroke, MI, or sudden death. Further studies are needed to clarify
optimal therapy for these patients.
© 1998 American Heart Association, Inc.
Original Contributions
Prognosis of Patients With Symptomatic Vertebral or Basilar Artery Stenosis
Key Words: aspirin • atherosclerosis • cerebrovascular disorders • stroke • warfarin
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|
|
|
|
 |
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
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|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|