Basilar Artery Occlusive Disease in the New England Medical Center Posterior Circulation Registry

Abstract

The basilar artery (BA) is the largest artery in the posterior circulation and forms the central core of this vascular territory. It is most commonly affected by atherosclerosis, and necropsy studies have found it to be one of the first and most severely involved of all intracranial arteries.¹ The BA is also affected by embolism, dissections, aneurysms, migraine, and inflammatory conditions.² Despite the wide range of underlying pathologic features, BA occlusive disease is an uncommon cause of stroke. Most reports have retrospectively described isolated cases or small series of patients.^3-10 Early reports were based on necropsy studies that emphasized clinicoanatomical correlations rather than the underlying vascular lesion, correlating focal brain lesions with symptoms and signs found during life.^4-6,11 Until recently, premortem diagnosis of posterior circulation vascular lesions required invasive techniques, such as catheter angiography, a procedure often not performed because it was considered risky and unnecessary to guide therapy. Consequently, many series included only select patients and did not reflect the true spectrum of disease.^7-10 Now new treatment options, such as thrombolysis and angioplasty and noninvasive diagnostic imaging techniques promote premortem diagnosis of BA occlusive disease. However, still few prospective studies are available,^12-15 and disparities remain regarding the natural history, underlying stroke mechanisms, vascular features, and prognosis of BA occlusive disease. We herein report an analysis of patients with moderate to severe stenosis or occlusion of the BA in the New England Medical Center Posterior Circulation Registry (NEMC-PCR), the largest prospective series of consecutively collected patients with posterior circulation ischemia to date.