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Bilateral occlusion of vertebral artery

Clinical patterns and long-term prognosis

Department of Clinical Neurological Sciences. University Hospital, London, Ontario, Canada.

We studied 17 patients with atherosclerotic bilateral occlusion of vertebral ateries (VA) identified by angiography. Seven had vertebrobasilar TIAs, eight a brainstem stroke (severe in two), and two had only carotid symptoms. Brainstem strokes were more frequent with bilateral intracranial occlusion (60%) than with at least one extracranial occlusion (28.6%), but long-term prognosis did not differ in these two groups. In follow-up, the mortality rate was 4.5% per year, and the stroke rate was 1.8% per year. Major functional disability was seen in 16.7% of the survivors. Bilateral distal VA occlusion may sometimes have a better prognosis than previously assumed. These findings raise doubts about the value of extra-intracranial surgical bypass procedures in patients with these lesions.

Address correspondence and reprint requests to Dr. Barnett. Department of Clinical Neurological Sciences, University Hospital, London. Ontario. Canada N6A 5A5.

Dr. Bogousslavsky was supported by the Schweizerische Stiftung fur Medizinische und Biologische Stipendien and the SICPA foundation.

Presented in part at the thirty-seventh annual meeting of the American Academy of Neurology. Dallas. TX, April 1985.

Accepted for publication February 7, 1986.

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