Basilar artery occlusive disease in stroke survivors in a multiethnic population

Ciríaco, Jovana Gobbi Marchesi; da Costa Leite, Claudia; da Graça Morais Martin, Maria; Barros, Cristiano Venturim; Puglia, Paulo; Caldas, José Guilherme Pereira; Scaff, Milberto; Conforto, Adriana Bastos

doi:10.1016/j.clineuro.2009.11.019

« Previous Next »Clinical Neurology and Neurosurgery
Volume 112, Issue 3 , Pages 233-236, April 2010

Basilar artery occlusive disease in stroke survivors in a multiethnic population☆

Jovana Gobbi Marchesi Ciríaco
- Neurology Department, Hospital das Clínicas, São Paulo University, São Paulo, Brazil
- Corresponding author. Tel.: +55 2733893983; fax: +55 2733155228.
Claudia da Costa Leite
- Radiology Department, Hospital das Clínicas, São Paulo University, São Paulo, Brazil
Maria da Graça Morais Martin
- Radiology Department, Hospital das Clínicas, São Paulo University, São Paulo, Brazil
Cristiano Venturim Barros
- Radiology Department, Hospital das Clínicas, São Paulo University, São Paulo, Brazil
Paulo Puglia Jr.
- Radiology Department, Hospital das Clínicas, São Paulo University, São Paulo, Brazil
José Guilherme Pereira Caldas
- Radiology Department, Hospital das Clínicas, São Paulo University, São Paulo, Brazil
Milberto Scaff
- Neurology Department, Hospital das Clínicas, São Paulo University, São Paulo, Brazil
Adriana Bastos Conforto
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil

Received 9 September 2008; received in revised form 30 September 2009; accepted 30 November 2009.

Abstract

Objectives

To describe clinical, radiological findings, and outcome in a multiethnic population of stroke survivors with basilar artery occlusive disease (BAOC).

Methods

Forty patients with infarcts in the basilar artery (BA) territory, alive 30 days after the ictus, participated in the study. BA stenosis (>50%) or occlusion was shown by magnetic resonance or digital subtraction angiography in all patients. Demographical, clinical and radiological characteristics were described. Modified Rankin Scale (MRS) scores at 30 days and 6 months after the ischemic event were evaluated. Association between demographical, clinical, radiological features and outcome were analyzed with Chi-square and Fisher's exact tests. MRS scores at 30 days and 6 months were compared with the Wilcoxon test.

Results

Sixty percent of the patients were men, and 33% were Afro-Brazilian. Mean age was 55.8±12.9 years. Most (90%) had multiple vascular risk factors. Stroke was preceded by TIA in 48% of the patients, and 80% had a history of arterial hypertension. The most common neurological symptom was vertigo/dizziness (60%) and the sign, hemiparesis (60%). Most of the infarcts were located in the pons (85%) and the BA middle third was the most frequently affected segment (33%). BA occlusion occurred in 58% of the patients. More severe vascular occlusive lesions were present in Whites (p=0.002) and in patients with involvement of the middle third of the BA (p=0.021). Large-artery atherosclerosis was the most common stroke etiology (88%) and was more frequent in older patients (p<0.001). Most patients were treated with anticoagulation. MRS scores improved significantly at 6 months (p<0.001); at this time, 78% of the patients had MRS scores between 0 and 2.

Conclusions

We observed different results compared with other series: greater proportion of Afro-descendents, higher frequency of atherosclerosis and BA occlusion. Rates of preceding TIAs and good outcome at 6 months were similar to previously published data. These results represent a step forward towards understanding BAOC in a multiethnic context.

Keywords: Basilar occlusive disease, Basilar artery, Posterior territory, Stroke