Clinical Outcome of Patients with Acute Posterior Circulation Stroke and Bilateral Vertebral Artery Occlusion

Abstract

Background and Introduction: Patients presenting with posterior circulation acute ischemic events are occasionally noted to have occlusion
of bilateral vertebral arteries with basilar artery blood flow entirely dependent from the anterior circulation. There islimited data about
prognosis of such patients in literature.
Methods: Patients with acute posterior circulation ischemic stroke and bilateral
vertebral artery occlusion (including contra-lateral hypoplastic vertebral artery without
contribution to the basilar artery system)were identified prospectively fromtwo academic
centers. Data including clinical presentation, medical management, angiographic findings,
recurrent events and outcome were collected and reported.
Results: A total of 4 patients presenting with acute ischemic events in the posterior
circulation were identified to have bilateral vertebral artery occlusion at our center.
One additional patient had a vertebral artery occlusion and a contra-lateral hypoplastic
vertebral artery. In the functional evaluation of the blood flow with catheter angiography,
the basilar artery was filling from the anterior circulation, with no antegrade flow from
bilateral vertebral arteries injection in all 5 patients. Patients were treated with antiplatelets (n=4) or started on anti-coagulation after failing anti-platelet therapy (n=2). All
patients had recurrent ischemic stroke with new ischemic lesions proven by diffusion
weighted images on MRI within 2 to 70 days after the initial event.
Conclusion: Patients with acute posterior circulation ischemic stroke and bilateral vertebral artery occlusion are at high risk of having
early recurrent ischemic events. Reestablishment of the antegrade vertebro-basilar blood flow through endovascular re-canalization
might be an option to decrease stroke recurrence in selected patients with acute posterior circulation stroke and bilateral vertebral
artery occlusion.