Basilar artery disease —Clinical outcome and doppler sonographical follow-up

Summary

In the past 5 years we have investigated 29 patients with symptomatic basilar artery stenoses (14 cases) and occlusions (14) and a patent primitive trigeminal artery with thin-calibered basilar and vertebral arteries (1) using directional continuous-wave Doppler sonography of the vertebral arteries. A total of 19 patients survived, and 17 of them were clinically and sonographically reexamined after 40.4 ± 15.8 months (mean ± SD). Among the 8 patients with basilar stenoses, 6 — with no further transient ischemic attacks (TIAs) in the interval — exhibited an increase in the summed modified Pourcelot indices (relative end-diastolic flow velocities) of the vertebrals by 0.18 ± 0.16; the other 2 showed a decrease by 0.26 each, in 1 case temporally related to a TIA, in the 2nd case without further clinical deterioration. In the 8 survivors with basilar occlusions, 5 remained — by sonographic criteria — unchanged with summed modified Pourcelot indices of the vertebrals of 0.00, while 3 patients exhibited a slight increase in the summed modified Pourcelot indices of 0.13 ± 0.03. While the difference between the outcome of subsets of patients treated with regimens of 30,000–40,000 units heparin/day or phenprocoumon and less radical drugs were statistically not significant, the former regimen appeared clinically more efficacious in preventing further deterioration in approximately two-thirds of the patients affected. Due to the potential recurrence of neurological symptoms, a treatment period with phenprocoumon of 6 months after discharge from hospital appears justified. Due to these therapeutic efforts, approximately half of the patients initially affected survived with no or only a mild neurological deficit. Directional continuous-wave Doppler sonography is, in our opinion, a reliable technique for examining the short- and long-term changes in peripheral vascular resistance.