background While diffuse atherosclerotic disease affecting the posterior circulation has been described extensively,the prevalence,natural history and angiographic characteristics of isolated symptomatic basilar arter...background While diffuse atherosclerotic disease affecting the posterior circulation has been described extensively,the prevalence,natural history and angiographic characteristics of isolated symptomatic basilar artery stenosis(ISBAS)remain unknown.Methods We reviewed our prospective institutional database to identify patients with≥50% symptomatic basilar artery(BA)stenosis without significant atherosclerotic burden in the vertebral or posterior cerebral arteries.Stroke mechanism,collateral circulation,and degree and length of stenosis were analysed.The primary outcome was time from index event to new transient ischaemic attack(TIA),acute ischaemic stroke(AIS)or death.Other outcome variables included modified Rankin Scale(mRS)score on discharge and last follow-up.results Of 6369 patients with AIS/TIA,91(1.43%)had ISBAS.Seventy-three(80.2%)patients presented with AIS and 18(19.8%)with TIA.Twenty-nine(31.9%)were women and the median age was 66.8±13.6 years.The mean follow-up time was 2.7 years.The most common stroke mechanism was artery-to artery thromboembolism(45.2%),followed by perforator occlusion(28.7%)and flow-dependent/hypoperfusion(15.1%).The percentage of stenosis was lower in patients who had favourable outcome compared with those with mRS 3-6 on discharge(78.3±14.3 vs 86.9±14.5,p=0.007).Kaplan-Meier curves showed higher recurrence/death rates in patients with≥80% stenosis,mid-basilar location and poor collateral circulation.Approximately 13% of patients with ISBAS presented with complete BA occlusion.Conclusion ISBAS is an uncommon(1.43%)cause of TIA and AIS.Men in their 60s are mostly affected,and artery-to artery embolism is the most common stroke mechanism.Mid-basilar location,≥80% stenosis and poor collateral circulation are important factors associated with worse prognosis.展开更多
背景和目的2015年10月5日至6日在美国华盛顿特区召开的第4届卒中治疗专业学术圆桌会议(Stroke Treatment Academy Industry Roundtable,STAIR)期间,卒中影像学研究(Stroke Imaging Research Group,STIR)组、卒中网络影像学工作组、美国...背景和目的2015年10月5日至6日在美国华盛顿特区召开的第4届卒中治疗专业学术圆桌会议(Stroke Treatment Academy Industry Roundtable,STAIR)期间,卒中影像学研究(Stroke Imaging Research Group,STIR)组、卒中网络影像学工作组、美国神经放射学学会和美国神经放射学学会基金会共同举办了一次影像学会议和研讨会。本路径图的目的是关注影像学在将来的研究和临床试验中的作用。方法此次会议将卒中神经病学专家、神经放射学专家、神经影像学研究人员、美国国立神经疾病与卒中研究所(National Institute of Neuro Wlgical Dworders and Stroke,NINDS)成员、企业代表以及美国食品药品管理局(Food and Drug Administramion,)成员汇聚一堂,根据前所未有的一系列急性卒中血管内治疗临床试验的阳性结果来探讨将来STIR的重点。结果此次影像学会议对影像学在近期阳性血管内治疗试验中的作用进行了总结和比较,并且提出了汇总分析的可能。此次影像学研讨会对多重影像学模式中采集和分析缺血核心、半暗带不匹配以及侧支循环的最佳成像方法制定出共识推荐,并且提出了在前瞻性临床试验中测量最终梗死灶体积的标准化方法。结论近期的阳性急性卒中血管内治疗临床试验证明了神经血管成像的额外价值。血管内治疗的最佳影像学特征包括大血管闭塞、梗死核心较小、侧支循环良好和半暗带较大。然而,可能需要利用来自近期阳性血管内治疗试验的汇总数据对这些影像学特征参数在不同成像模式之间进行等效定义以及做出标准化尝试。展开更多
文摘background While diffuse atherosclerotic disease affecting the posterior circulation has been described extensively,the prevalence,natural history and angiographic characteristics of isolated symptomatic basilar artery stenosis(ISBAS)remain unknown.Methods We reviewed our prospective institutional database to identify patients with≥50% symptomatic basilar artery(BA)stenosis without significant atherosclerotic burden in the vertebral or posterior cerebral arteries.Stroke mechanism,collateral circulation,and degree and length of stenosis were analysed.The primary outcome was time from index event to new transient ischaemic attack(TIA),acute ischaemic stroke(AIS)or death.Other outcome variables included modified Rankin Scale(mRS)score on discharge and last follow-up.results Of 6369 patients with AIS/TIA,91(1.43%)had ISBAS.Seventy-three(80.2%)patients presented with AIS and 18(19.8%)with TIA.Twenty-nine(31.9%)were women and the median age was 66.8±13.6 years.The mean follow-up time was 2.7 years.The most common stroke mechanism was artery-to artery thromboembolism(45.2%),followed by perforator occlusion(28.7%)and flow-dependent/hypoperfusion(15.1%).The percentage of stenosis was lower in patients who had favourable outcome compared with those with mRS 3-6 on discharge(78.3±14.3 vs 86.9±14.5,p=0.007).Kaplan-Meier curves showed higher recurrence/death rates in patients with≥80% stenosis,mid-basilar location and poor collateral circulation.Approximately 13% of patients with ISBAS presented with complete BA occlusion.Conclusion ISBAS is an uncommon(1.43%)cause of TIA and AIS.Men in their 60s are mostly affected,and artery-to artery embolism is the most common stroke mechanism.Mid-basilar location,≥80% stenosis and poor collateral circulation are important factors associated with worse prognosis.
文摘背景和目的2015年10月5日至6日在美国华盛顿特区召开的第4届卒中治疗专业学术圆桌会议(Stroke Treatment Academy Industry Roundtable,STAIR)期间,卒中影像学研究(Stroke Imaging Research Group,STIR)组、卒中网络影像学工作组、美国神经放射学学会和美国神经放射学学会基金会共同举办了一次影像学会议和研讨会。本路径图的目的是关注影像学在将来的研究和临床试验中的作用。方法此次会议将卒中神经病学专家、神经放射学专家、神经影像学研究人员、美国国立神经疾病与卒中研究所(National Institute of Neuro Wlgical Dworders and Stroke,NINDS)成员、企业代表以及美国食品药品管理局(Food and Drug Administramion,)成员汇聚一堂,根据前所未有的一系列急性卒中血管内治疗临床试验的阳性结果来探讨将来STIR的重点。结果此次影像学会议对影像学在近期阳性血管内治疗试验中的作用进行了总结和比较,并且提出了汇总分析的可能。此次影像学研讨会对多重影像学模式中采集和分析缺血核心、半暗带不匹配以及侧支循环的最佳成像方法制定出共识推荐,并且提出了在前瞻性临床试验中测量最终梗死灶体积的标准化方法。结论近期的阳性急性卒中血管内治疗临床试验证明了神经血管成像的额外价值。血管内治疗的最佳影像学特征包括大血管闭塞、梗死核心较小、侧支循环良好和半暗带较大。然而,可能需要利用来自近期阳性血管内治疗试验的汇总数据对这些影像学特征参数在不同成像模式之间进行等效定义以及做出标准化尝试。
