Adnan I Qureshi1, Mushtaq H Qureshi2, Li-Ming Lien3, Jiunn-Tay Lee4, Jiann-Shing Jeng5, Chaur-Jong Hu6, Ta-Chang Lai7, Chung-Hsiang Liu8, Chih-Hung Chen9, Po-Lin Chen10, Tsang-Shan Chen11, Jie-Yuan Li12, Cheng-Li Lin13, Chung Y Hsu13. 1. Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, USA. 2. Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, USA, mushtaqhq@gmail.com. 3. Department of Neurology, Shin Kong WHS Memorial Hospital, Taipei, Taiwan. 4. Department of Neurology, Tri-Service General Hospital, Taipei, Taiwan. 5. Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan. 6. Department of Neurology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan. 7. Department of Neurology, Cheng Hsin General Hospital, Taipei, Taiwan. 8. Department of Neurology, China Medical University Hospital, Taichung, Taiwan. 9. Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan. 10. Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan. 11. Department of Neurology, Tainan Sin-Lau Hospital, Tainan, Taiwan. 12. Department of Neurology, E-Da Hospital, Kaohsiung, Taiwan. 13. College of Medicine, China Medical University, Taichung, Taiwan.
Abstract
BACKGROUND: The natural history of vertebrobasilar artery (VBA) stenosis or occlusion remains understudied. METHODS: Patients with diagnosis of ischemic stroke or transient ischemic attack (TIA) who were noted to have VBA stenosis based on computed tomography or magnetic resonance imaging or catheter-based angiogram were selected from Taiwan Stroke Registry. Cox proportional hazards model was used to determine the hazards ratio (HR) of recurrent stroke and death within 1 year of index event in various groups based on severity of VBA stenosis (none to mild: 0-49%; moderate to severe: 50-99%: occlusion: 100%) after adjusting for differences in demographic and clinical characteristics between groups at baseline evaluation. RESULTS: None to mild or moderate to severe VBA stenosis was diagnosed in 6972 (66%) and 3,137 (29.8%) among 10,515 patients, respectively, and occlusion was identified in 406 (3.8%) patients. Comparing with patients who showed none to mild stenosis of VBA, there was a significantly higher risk of recurrent stroke (HR 1.21, 95% CI 1.01-1.45) among patients with moderate to severe VBA stenosis. There was a nonsignificantly higher risk of recurrent stroke (HR 1.49, 95% CI 0.99-2.22) and significantly higher risk of death (HR 2.21, 95% CI 1.72-2.83), among patients with VBA occlusion after adjustment of potential confounders. CONCLUSIONS: VBA stenosis or occlusion was relatively prevalent among patients with TIA or ischemic stroke and associated with higher risk of recurrent stroke and death in patients with ischemic stroke or TIA who had large artery atherosclerosis.
BACKGROUND: The natural history of vertebrobasilar artery (VBA) stenosis or occlusion remains understudied. METHODS:Patients with diagnosis of ischemic stroke or transient ischemic attack (TIA) who were noted to have VBA stenosis based on computed tomography or magnetic resonance imaging or catheter-based angiogram were selected from Taiwan Stroke Registry. Cox proportional hazards model was used to determine the hazards ratio (HR) of recurrent stroke and death within 1 year of index event in various groups based on severity of VBA stenosis (none to mild: 0-49%; moderate to severe: 50-99%: occlusion: 100%) after adjusting for differences in demographic and clinical characteristics between groups at baseline evaluation. RESULTS: None to mild or moderate to severe VBA stenosis was diagnosed in 6972 (66%) and 3,137 (29.8%) among 10,515 patients, respectively, and occlusion was identified in 406 (3.8%) patients. Comparing with patients who showed none to mild stenosis of VBA, there was a significantly higher risk of recurrent stroke (HR 1.21, 95% CI 1.01-1.45) among patients with moderate to severe VBA stenosis. There was a nonsignificantly higher risk of recurrent stroke (HR 1.49, 95% CI 0.99-2.22) and significantly higher risk of death (HR 2.21, 95% CI 1.72-2.83), among patients with VBA occlusion after adjustment of potential confounders. CONCLUSIONS: VBA stenosis or occlusion was relatively prevalent among patients with TIA or ischemic stroke and associated with higher risk of recurrent stroke and death in patients with ischemic stroke or TIA who had large artery atherosclerosis.
Authors: Sepideh Amin-Hanjani; Alfred P See; Xinjian Du; Linda Rose-Finnell; Dilip K Pandey; Yi-Fan Chen; Mitchell S V Elkind; Gregory J Zipfel; David S Liebeskind; Frank L Silver; Scott E Kasner; Philip B Gorelick; Fady T Charbel; Colin P Derdeyn Journal: Stroke Date: 2020-10-09 Impact factor: 7.914
Authors: Alfred P See; Dilip K Pandey; Xinjian Du; Linda Rose-Finnell; Fady T Charbel; Colin P Derdeyn; Sepideh Amin-Hanjani Journal: J Am Heart Assoc Date: 2020-06-05 Impact factor: 5.501