Clinical Analysis Of Symptomatic Intracranial Vertebral Artery Stenosis

Objection:To investigate the clinical characteristics, imaging features, treatment and prognosis of patients with symptomatic intracranial vertebral artery (ICVA) stenosis.Methods:Ten patients with ICVA stenosis who hospitalized in the neurology department of our hospital since January2014to Match2015were recruited. All patients’medical records were retrospectively reviewed and a short time follow-up was conducted. All patients received brain magnetic resonance imaging, digital subtraction angiography (DSA) and transcranial doppler ultrasound(TCD) examinations. According to the result of examinations, the characteristics of ICVA lesions was analyzed combined with clinical features, treatment and prognosis.Results:Ten cases with ICVA stenosis were identified, including8male and2female patients. The mean age was60±9.24years old. Six patients were diagnosed with posterior circulation transient ischemic attack (TIA) while the other four with posterior circulation ischemic stroke. Eight patients had hypertension, four had diabetes mellitus, three had hyperhomocysteinemia, two had dyslipidemia and four were smokers. Dizziness/vertigo, unsteady gait, dysarthria and limb sensory and motor disorders were most common clinical symptoms. Six patients was found with unilateral ICVA stenosis and four were bilateral involved. Six patients were found with other lesions of more than50%stenosis, including vertebral artery origin, middle cerebral artery, internal carotid artery and basilar artery. Vertebral dominance was observed in seven patients. The predilection site of stenosis or occlusion in ICVA in order was distal (8/14), proximal (5/14) and middle (1/14). Three of four patients with stroke had bilateral ICVA lesions. Five of six patients with TIA had unilateral ICVA stenosis. Among six patients with unilateral ICVA stenosis, the blood velocity of vertebral artery in the affected side decreased and was less than40cm/s. The systolic velocity and mean velocity were significantly lower in the stenosis side (P<0.05) and pulsatility index was significantly higher (P<0.01) compared with the contralateral side. All patients received antiplatelet therapy and risk factors were under aggressive controll. Five patients received endovascular stenting treatment with successful procedure and no perioperative complication was observed. During6.8±3.68months follow-up, all of ten patients were living without new stroke event. Most patients had good prognosis except for one stroke patient with sequelae of moderate disability.Conclusion:The clinical symptoms of symptomatic ICVA stenosis are lack of specificity. Stenosis or occlusion in other lesions and vertebral dominance are common comorbidities. Occlusive atherosclerotic lesions within ICVA most often develop at the distal portion of the artery. Bilateral ICVA lesions are more common in patients with stroke. The results of TCD show the change of lower blood velocity and higher pulsatility index proximal within the stenosis side. Most patients have a good short-term prognosis.