warfarin and Intracranial-Arteriosclerosis

Patients with symptomatic intracranial atherosclerotic disease have a high risk of recurrent stroke, and secondary prevention in these patients remains a challenge. Aggressive medical management of vascular risk factors is safe and effective for most high risk patients, but the role of endovascular and surgical therapies still remain uncertain. Future studies may identify novel therapeutic strategies for patients with intracranial atherosclerotic disease, but aggressive risk factor control remains the mainstay of evidenced-based treatment at this time.

Topics: Aspirin; Carotid Artery, Common; Carotid Stenosis; Clopidogrel; Constriction, Pathologic; Drug Therapy, Combination; Female; Fibrinolytic Agents; Humans; Intracranial Arteriosclerosis; Male; Platelet Aggregation Inhibitors; Risk Factors; Risk Reduction Behavior; Secondary Prevention; Stroke; Ticlopidine; Treatment Outcome; United States; Warfarin

The Gateway balloon-Wingspan stent system is the first, and currently the only "on-label" device for the treatment of symptomatic intracranial stenosis in the United States. In initial single-arm studies, investigators have indicated that this system can be used for the treatment of symptomatic intracranial atherosclerotic disease with high levels of technical success and acceptable periprocedural complication rates, which are comparable with, or better than, those reported for other endovascular techniques. Intermediate- and long-term follow-up data for patients treated with the Wingspan device remain sparse. We critically review the existing data, which characterize the risk profile and efficacy of endovascular interventions for intracranial atherosclerotic disease, as well as the available clinical evidence that could be used to select appropriate patients for treatment.

Topics: Angioplasty, Balloon; Anticoagulants; Aspirin; Brain Ischemia; Cerebral Arteries; Constriction, Pathologic; Endovascular Procedures; Fibrinolytic Agents; Humans; Intracranial Arteriosclerosis; Platelet Aggregation Inhibitors; Prognosis; Secondary Prevention; Stents; Treatment Outcome; Warfarin

Atherosclerotic intracranial stenosis is an important cause of stroke in blacks, yet there are limited data on vascular risk factors and outcome. We analyzed the vascular risk factors and outcomes of blacks and whites in the Warfarin versus Aspirin for Symptomatic Intracranial Disease (WASID) trial.. Baseline characteristics and outcomes (ischemic stroke, brain hemorrhage, or vascular death combined and ischemic stroke alone) were compared between blacks (n=174) and whites (n=331) using univariate and multivariate analyses.. Blacks were significantly (P<0.05) more likely than whites to be/have: female, hypertension history, diabetes history, higher LDL, higher total cholesterol, lower triglycerides, unmarried, unemployed, nonprivate insurance, no insurance, stroke as qualifying event, <70% stenosis, symptomatic anterior circulation vessel, no antithrombotic medication before qualifying event, and no family history of myocardial infarction. Blacks more frequently reached an end point of ischemic stroke, brain hemorrhage or vascular death (28% versus 20%; hazard ratio of 1.49, 95% CI 1.03 to 2.17, P=0.03), had a higher 2-year event rate (0.28 versus 0.19), and reached the end point of ischemic stroke alone (25% versus 16% at 2 years; hazard ratio of 1.62, P=0.017). In multivariate analysis, race was associated with ischemic stroke (P=0.0488) but not with the end point ischemic stroke, brain hemorrhage or vascular death (P=0.188).. Blacks with intracranial stenosis are at higher risk of stroke recurrence than whites. This risk warrants additional study of factors contributing to stroke in blacks and highlights the need for aggressive risk factor management in blacks to prevent recurrence.

Topics: Aged; Anticoagulants; Aspirin; Black People; Canada; Cerebral Angiography; Constriction, Pathologic; Double-Blind Method; Endpoint Determination; Female; Hemodynamics; Humans; Intracranial Arteriosclerosis; Male; Middle Aged; Platelet Aggregation Inhibitors; Racial Groups; Risk Factors; Socioeconomic Factors; United States; Warfarin; White People

Few data exist about the prognostic value of serum white blood cell (WBC) count among patients with symptomatic cerebrovascular disease. We investigated the relationship between WBC count and vascular risk in patients with symptomatic intracranial atherosclerotic disease enrolled in the Warfarin-Aspirin Symptomatic Intracranial Disease(WASID) study.. The relationships between baseline serum WBC count (categorized into quartiles) and both ischemic stroke alone and the combined endpoint of ischemic stroke, myocardial infarction or vascular death were evaluated using the log-rank test and Cox proportional hazards regression.. Compared with the quartile with the lowest WBC counts at baseline (< or =5.9 x 10(9)/l), WASID subjects in both upper WBC quartiles (7.3-8.8; > or =8.9 x 10(9)/l) were more likely to be younger (p = 0.022), diabetic (p = 0.013), on statin treatment (p = 0.015), or have higher mean body mass index (p = 0.015) and triglyceride (p = 0.0065) values. The rate of the primary endpoint was greater among WASID subjects in the upper two WBC quartiles compared with the lower two quartiles (28 vs. 16%, hazard ratio = 1.7; 95% CI = 1.2-2.5, p = 0.003). After adjusting for baseline factors found to be significantly related to the time of primary endpoint in multivariate analysis, both upper WBC quartiles (vs. lowest quartile) were independently associated with a greater risk for the primary endpoint (hazard ratio of 1.5; 95% CI = 1.06-2.2, p = 0.024).. An elevated WBC count at study entry was associated with an increased risk of stroke and vascular death in patients with symptomatic intracranial atherosclerotic disease enrolled in the WASID trial.

Topics: Adult; Aged; Anticoagulants; Aspirin; Constriction, Pathologic; Female; Humans; Intracranial Arteriosclerosis; Leukocyte Count; Male; Middle Aged; Myocardial Infarction; Prognosis; Proportional Hazards Models; Risk Assessment; Risk Factors; Stroke; Time Factors; Warfarin

Atherosclerotic intracranial arterial stenosis is an important cause of stroke. Warfarin is commonly used in preference to aspirin for this disorder, but these therapies have not been compared in a randomized trial.. We randomly assigned patients with transient ischemic attack or stroke caused by angiographically verified 50 to 99 percent stenosis of a major intracranial artery to receive warfarin (target international normalized ratio, 2.0 to 3.0) or aspirin (1300 mg per day) in a double-blind, multicenter clinical trial. The primary end point was ischemic stroke, brain hemorrhage, or death from vascular causes other than stroke.. After 569 patients had undergone randomization, enrollment was stopped because of concerns about the safety of the patients who had been assigned to receive warfarin. During a mean follow-up period of 1.8 years, adverse events in the two groups included death (4.3 percent in the aspirin group vs. 9.7 percent in the warfarin group; hazard ratio for aspirin relative to warfarin, 0.46; 95 percent confidence interval, 0.23 to 0.90; P=0.02), major hemorrhage (3.2 percent vs. 8.3 percent, respectively; hazard ratio, 0.39; 95 percent confidence interval, 0.18 to 0.84; P=0.01), and myocardial infarction or sudden death (2.9 percent vs. 7.3 percent, respectively; hazard ratio, 0.40; 95 percent confidence interval, 0.18 to 0.91; P=0.02). The rate of death from vascular causes was 3.2 percent in the aspirin group and 5.9 percent in the warfarin group (P=0.16); the rate of death from nonvascular causes was 1.1 percent and 3.8 percent, respectively (P=0.05). The primary end point occurred in 22.1 percent of the patients in the aspirin group and 21.8 percent of those in the warfarin group (hazard ratio, 1.04; 95 percent confidence interval, 0.73 to 1.48; P=0.83).. Warfarin was associated with significantly higher rates of adverse events and provided no benefit over aspirin in this trial. Aspirin should be used in preference to warfarin for patients with intracranial arterial stenosis.

Topics: Adult; Aged; Anticoagulants; Aspirin; Cardiovascular Diseases; Double-Blind Method; Female; Fibrinolytic Agents; Hemorrhage; Humans; Intracranial Arteriosclerosis; Ischemic Attack, Transient; Male; Middle Aged; Mortality; Secondary Prevention; Stroke; Warfarin

To determine the prognosis of patients with symptomatic intracranial atherosclerosis who fail antithrombotic therapy.. The outcome of patients with symptomatic intracranial atherosclerosis who fail antithrombotic therapy is unknown. These patients may represent the target group for investigation of more aggressive therapies such as intracranial angioplasty.. The authors performed a chart review and telephone interview of patients with symptomatic intracranial atherosclerosis identified in the Stanford Stroke Center clinical database. A Cox regression model was created to identify factors predictive of failure of antithrombotic therapy. The authors generated Kaplan-Meier survival curves to determine the timing of recurrent TIA, stroke, or death after failure of antithrombotic therapy.. Fifty-two patients had symptomatic intracranial atherosclerosis and fulfilled entry criteria. Twenty-nine of the 52 patients (55.8%) had cerebral ischemic events while receiving an antithrombotic agent (antiplatelet agents [55%], warfarin [31%], or heparin [14%]). In a Cox regression model, older age was an independent predictor of failure of antithrombotic therapy, and warfarin use was associated with a decrease in risk. Recurrent TIA (n = 7), nonfatal/fatal stroke (n = 6/1), or death (n = 1) occurred in 15 of 29 (51.7%) of the patients who failed antithrombotic therapy. The median time to recurrent TIA, stroke, or death was 36 days (95% CI 13 to 59).. Patients with symptomatic intracranial atherosclerosis who fail antithrombotic therapy have extremely high rates of recurrent TIA/stroke or death. Recurrent ischemic events typically occur within a few months after failure of standard medical therapy. The high recurrence risk observed warrants testing of alternative treatment strategies such as intracranial angioplasty.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Female; Fibrinolytic Agents; Follow-Up Studies; Heparin; Humans; Intracranial Arteriosclerosis; Male; Middle Aged; Platelet Aggregation Inhibitors; Proportional Hazards Models; Recurrence; Risk Assessment; Stroke; Survival Analysis; Survival Rate; Treatment Failure; Treatment Outcome; Warfarin

Understanding factors associated with ischemic stroke despite therapeutic anticoagulation is an important goal to improve stroke prevention strategies in patients with atrial fibrillation (AF). We aim to determine factors associated with therapeutic or supratherapeutic anticoagulation status at the time of ischemic stroke in patients with AF.. The Initiation of Anticoagulation after Cardioembolic stroke (IAC) study is a multicenter study pooling data from stroke registries of eight comprehensive stroke centers across the United States. Consecutive patients hospitalized with acute ischemic stroke in the setting of AF were included in the IAC cohort. For this study, we only included patients who reported taking warfarin at the time of the ischemic stroke. Patients not on anticoagulation and patients who reported use of a direct oral anticoagulant were excluded. Analyses were stratified based on therapeutic (INR ≥2) versus subtherapeutic (INR <2) anticoagulation status. We used binary logistic regression models to determine factors independently associated with anticoagulation status after adjustment for pertinent confounders. In particular, we sought to determine whether atherosclerosis with 50% or more luminal narrowing in an artery supplying the infarct (a marker for a competing atherosclerotic mechanism) and small stroke size (≤ 10 mL; implying a competing small vessel disease mechanism) related to anticoagulant status.. Of the 2084 patients enrolled in the IAC study, 382 patients met the inclusion criteria. The mean age was 77.4 ± 10.9 years and 52.4% (200/382) were women. A total of 222 (58.1%) subjects presented with subtherapeutic INR. In adjusted models, small stroke size (OR 1.74 95% CI 1.10-2.76, p = 0.019) and atherosclerosis with 50% or more narrowing in an artery supplying the infarct (OR 1.96 95% CI 1.06-3.63, p = 0.031) were independently associated with INR ≥2 at the time of their index stroke.. Small stroke size (≤ 10 ml) and ipsilateral atherosclerosis with 50% or more narrowing may indicate a competing stroke mechanism. There may be important opportunities to improve stroke prevention strategies for patients with AF by targeting additional ischemic stroke mechanisms to improve patient outcomes.

Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Blood Coagulation; Brain Ischemia; Drug Monitoring; Female; Humans; International Normalized Ratio; Intracranial Arteriosclerosis; Male; Recurrence; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Stroke; Time Factors; Treatment Outcome; United States; Warfarin

Medical and endovascular treatment options for stroke prevention in patients with symptomatic intracranial stenosis have evolved over the past several decades, but the impact of 2 major multicenter randomized stroke prevention trials on physician practices has not been studied. We sought to determine changes in US physician treatment choices for patients with intracranial atherosclerotic stenosis (ICAS) following 2 NIH-funded clinical trials that studied medical therapies (antithrombotic agents and risk factor control) and percutaneous transluminal angioplasty and stenting (PTAS).. Anonymous surveys on treatment practices in patients with ICAS were sent to physicians at 3 time points: before publication of the NIH-funded Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial (pre-WASID survey, 2004), 1 year after WASID publication (post-WASID survey, 2006) and 1 year after the publication of the NIH-funded Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial (post-SAMMPRIS survey, 2012). Neurologists were invited to participate in the pre-WASID survey (n=525). Neurologists and neurointerventionists were invited to participate in the post-WASID (n=598) and post-SAMMPRIS (n=2,080) surveys. The 3 surveys were conducted using web-based survey tools delivered by E-mail, and a fax-based response form delivered by E-mail and conventional mail. Data were analyzed using the χ2 test.. Before WASID, there was equipoise between warfarin and aspirin for stroke prevention in patients with ICAS. The number of respondents who recommended antiplatelet treatment for ICAS increased across all 3 surveys for both anterior circulation (pre-WASID=44%, post-WASID=85%, post-SAMMPRIS=94%) and posterior circulation (pre-WASID=36%, post-WASID=74%, post-SAMMPRIS=83%). The antiplatelet agent most commonly recommended after WASID was aspirin, but after SAMMPRIS it was the combination of aspirin and clopidogrel. The percentage of neurologists who recommended PTAS in >25% of ICAS patients increased slightly from pre-WASID (8%) to post-WASID surveys (12%), but then decreased again after SAMMPRIS (6%). The percentage of neurointerventionists who recommended PTAS in >25% of ICAS patients decreased from post-WASID (49%) to post-SAMMPRIS surveys (17%).. The surveyed US physicians' recommended treatments for ICAS differed over the 3 survey periods, reflecting the results of the 2 NIH-funded clinical trials of ICAS and suggesting that these clinical trials changed practice in the USA.

Topics: Angioplasty; Aspirin; Cerebral Arteries; Clopidogrel; Constriction, Pathologic; Drug Therapy, Combination; Drug Utilization; Fibrinolytic Agents; Health Care Surveys; Humans; Intracranial Arteriosclerosis; Neurology; Practice Patterns, Physicians'; Radiology, Interventional; Randomized Controlled Trials as Topic; Risk Reduction Behavior; Secondary Prevention; Stents; Stroke; Surveys and Questionnaires; Ticlopidine; United States; Warfarin

Topics: Anticoagulants; Aspirin; Cilostazol; Evidence-Based Medicine; Humans; Intracranial Arteriosclerosis; Platelet Aggregation Inhibitors; Randomized Controlled Trials as Topic; Secondary Prevention; Stroke; Tetrazoles; Treatment Outcome; Warfarin

A well-defined rate of adverse events following cerebral angiography in patients with symptomatic intracranial atherosclerosis would be useful to physicians making decisions regarding imaging and treatment of these patients. We report the adverse events associated with angiography in patients who underwent single-vessel cerebral angiography as part of the study protocol in the Warfarin-Aspirin for Symptomatic Intracranial Arterial Stenosis trial.. Single-vessel cerebral angiography was performed to specifically define the degree of stenosis in 196 patients suspected of having intracranial atherosclerotic stenosis on noninvasive tests. Adverse events that occurred within 24 h of cerebral angiography were reported by the sites performing the angiography.. Overall, neurological adverse events occurred in 4 patients (2.0%; 95% CI: 0.6-5.1%), and nonneurological adverse events occurred in 12 patients (6.1%; 95% CI: 3.2-10.5%). All of the neurological adverse events were transient.. The risk of permanent neurological adverse events associated with single-vessel cerebral angiography in patients with symptomatic intracranial atherosclerosis is relatively low. The quantification of the risk of cerebral angiography in patients with intracranial atherosclerosis provides useful information to consider when evaluating noninvasive imaging techniques for their relative value.

Topics: Anticoagulants; Aspirin; Cerebral Angiography; Fibrinolytic Agents; Humans; Intracranial Arteriosclerosis; Randomized Controlled Trials as Topic; Risk Factors; Warfarin

The impact of the Warfarin and Aspirin for Symptomatic Intracranial Disease (WASID) data is described in combination with the commercial release of the Wingspan stenting system on the frequency of neurointervention for the treatment of symptomatic intracranial atherosclerotic disease (ICAD) in a tertiary care center.. Endovascular case logs were reviewed from April 2004 to July 2007. The total number of intracranial neurointerventions and the number of neurointerventions (percutaneous transluminal angioplasty alone (PTA) or with stenting (PTAS)) performed for symptomatic ICAD were calculated. The time period evaluated was divided into two equal 19.5-month epochs representing the time periods before and after the availability of the Wingspan system.. The frequency of neurointerventions for ICAD increased by 763%, from seven of 354 total cases (2%) to 56 of 367 total cases (15.3%) (p<0.001) after the Wingspan system became available. The increase in intracranial PTAS volume occurred immediately and was stable throughout the "Wingspan era".. The publication of the WASID trial results combined with the availability of the Wingspan stent system led to a marked increase in the frequency of neurointervention for symptomatic ICAD at our institution. The adoption of this technology occurred without direct evidence that PTAS with Wingspan is superior to traditional medical therapy. These findings underscore the need for a randomized trial of stenting and medical therapy for the treatment of this disease process.

Topics: Angioplasty; Anticoagulants; Aspirin; Combined Modality Therapy; Drug Therapy, Combination; Evidence-Based Medicine; Hospitals, Special; Humans; Intracranial Arteriosclerosis; Neurology; Platelet Aggregation Inhibitors; Prognosis; Retrospective Studies; Risk Factors; Stents; Warfarin

There are limited data on the relationship between control of vascular risk factors and vascular events in patients with symptomatic intracranial arterial stenosis.. We utilized the Warfarin Aspirin Symptomatic Intracranial Disease study database to analyze vascular and lifestyle risk factors at baseline and averaged over the course of the trial. Cutoff levels defining good control for each factor were prespecified based on national guidelines. Endpoints evaluated included 1) ischemic stroke, myocardial infarction, or vascular death or 2) ischemic stroke alone. Univariate associations were assessed using the log-rank test and multivariable analysis was done using Cox proportional hazards regression.. From baseline until year 2 follow-up, there was not a significant improvement in blood pressure control. During the same period, there were improvements in patients with total cholesterol <200 mg/dL (54.6% to 79.2%, p < 0.001) or low-density lipoprotein <100 mg/dL (28.7% to 55.9%, p < 0.001). Multivariable analysis showed that systolic blood pressure >or=140 mm Hg (HR = 1.79, p = 0.0009, 95% confidence limits 1.27 to 2.52), no alcohol consumption (HR 1.69, 1.21 to 2.39, p = 0.002), and cholesterol >or=200 mg/dL (HR 1.44, 1.004 to 2.07, p = 0.048) were associated with an increased risk of stroke, myocardial infarction, or vascular death. The same risk factors were predictors of ischemic stroke alone in multivariable analysis.. Elevated blood pressure and cholesterol levels in symptomatic patients with intracranial stenosis are associated with an increased risk of stroke and other major vascular events.

Topics: Aged; Constriction, Pathologic; Female; Follow-Up Studies; Humans; Intracranial Arteriosclerosis; Male; Middle Aged; Multicenter Studies as Topic; Randomized Controlled Trials as Topic; Risk Factors; Stroke; Warfarin

The metabolic syndrome (MetS) is a cluster of risk factors linked to insulin resistance that increase an individual's risk of atherosclerotic vascular disease. The authors evaluated the prevalence and prognosis of the MetS among individuals with symptomatic intracranial arterial stenosis.. Patients enrolled in the Warfarin-Aspirin Symptomatic Intracranial Disease trial were evaluated in this post-hoc analysis. Baseline characteristics and outcome were compared in patients with the MetS vs patients without the MetS.. Among 476 patients, the prevalence of the MetS was 43%. MetS patients were more likely to be younger, female, and white. During a mean follow-up period of 1.8 years, time to the first of ischemic stroke, myocardial infarction, or vascular death was shorter among patients with the MetS with a hazard ratio (syndrome/no syndrome) of 1.6 (95% CI = 1.1 to 2.4, p = 0.0097). Time to ischemic stroke alone was also shorter among patients with the MetS with a hazard ratio (syndrome/no syndrome) of 1.7 (95% CI = 1.1 to 2.6, p = 0.012). When controlling for individual factors of the definition, MetS was not significant (combined outcome: p = 0.14; ischemic stroke: p = 0.074).. The metabolic syndrome is present in about half of individuals with symptomatic intracranial atherosclerotic disease and is associated with a substantially higher risk of major vascular events. The metabolic syndrome may not provide additional ability to predict outcomes beyond the individual factors for patients with intracranial stenosis.

Topics: Aged; Aspirin; Brain Ischemia; Cohort Studies; Comorbidity; Disease Progression; Double-Blind Method; Female; Follow-Up Studies; Humans; Incidence; Intracranial Arteriosclerosis; Male; Metabolic Syndrome; Middle Aged; Multicenter Studies as Topic; Myocardial Infarction; Proportional Hazards Models; Prospective Studies; Racial Groups; Randomized Controlled Trials as Topic; Risk; Risk Factors; Survival Analysis; Vascular Diseases; Warfarin

Topics: Anticoagulants; Aspirin; Dose-Response Relationship, Drug; Fibrinolytic Agents; Hemorrhage; Humans; Intracranial Arteriosclerosis; Ischemic Attack, Transient; Mortality; Stroke; Thromboembolism; Treatment Failure; Warfarin

Patients with intracranial vertebrobasilar artery (VBA) atherosclerotic occlusive disease have few therapeutic options. Unfortunately, VBA transient ischemic attacks (TIAs) herald a lethal or devastating event within 5 years in 25 to 30% of patients. The authors report their initial experience with eight patients in whom medically refractory TIAs secondary to intracranial posterior circulation atherosclerotic occlusive lesions were treated with stent-assisted angioplasty.. Eight patients (six men), ranging in age from 43 to 77 years, experienced signs and symptoms of VBA insufficiency despite combination therapy with warfarin and antiplatelet agents. Angiographic studies revealed severe distal vertebral (four patients), proximal basilar (one patient), or proximal and midbasilar stenoses (three patients). Aspirin and clopidogrel were administered for 3 days before primary angioplasty and stent placement, and this regimen was maintained by the patients on discharge. Patients underwent heparinization during the procedure and were given a bolus and 12-hour infusion of abciximab. A neurologist specializing in stroke evaluated all patients before and after the procedure. The VBAs in all patients were successfully revascularized with 7 to 28% residual stenosis. Six patients experienced no neurological complications. One patient died the evening of the procedure due to a massive subarachnoid hemorrhage. Two patients had groin hematomas, one developed congestive heart failure, and one had transient encephalopathy. All surviving patients are asymptomatic up to 8 months postoperatively.. Although primary intracranial VBA angioplasty with stent insertion is technically feasible, complications associated with the procedure can be life threatening. As experience is gained with this procedure, it may be offered routinely as an alternative therapy to patients with medically refractory posterior circulation occlusive disease that may develop into catastrophic VBA insufficiency.

Topics: Abciximab; Adult; Aged; Angiography; Angioplasty; Antibodies, Monoclonal; Anticoagulants; Aspirin; Basilar Artery; Cerebrovascular Circulation; Clopidogrel; Female; Follow-Up Studies; Heparin; Humans; Immunoglobulin Fab Fragments; Intracranial Arteriosclerosis; Ischemic Attack, Transient; Male; Middle Aged; Platelet Aggregation Inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex; Premedication; Stents; Stroke; Subarachnoid Hemorrhage; Ticlopidine; Vertebral Artery; Vertebrobasilar Insufficiency; Warfarin

We analyzed the clinical features of symptomatic posterior cerebral artery (PCA) stenosis in 6 patients selected from 15 patients with angiographically documented PCA atherostenosis occurring during a 7-year period. Transient ischemic attacks (TIAs) were the major presentation in 5 patients. A homonymous visual field defect was present in 2 patients. TIA symptoms were predominantly visual or sensory, or both. The most common visual symptom was difficulty seeing to one side. One patient saw flashing lights. Sensory spells were always paresthetic, usually involving the arm and hand and occasionally the face and leg. Three patients had visual and sensory spells together. Two patients with a visual field defect had calcarine infarcts found by computed tomography. All patients were treated with warfarin. During follow-up (4 months to 4 years), no patient had a new stroke in the PCA territory, and only one continued to have TIAs. PCA atherostenosis is rarer then PCA embolic occlusion. In contrast to those with PCA embolism, our patients with PCA atherostenosis had more TIAs and fewer infarcts. The clinical features of PCA stenosis--preponderance of visual and sensory TIAs--distinguish this vascular lesion from stenosis of the middle cerebral artery.

Topics: Aged; Cerebral Angiography; Constriction, Pathologic; Female; Follow-Up Studies; Humans; Intracranial Arteriosclerosis; Ischemic Attack, Transient; Male; Middle Aged; Tomography, X-Ray Computed; Vision Disorders; Warfarin

Topics: Aged; Anticoagulants; Blood Coagulation Tests; Dementia; Humans; Intracranial Arteriosclerosis; Warfarin

Topics: Anticoagulants; Coronary Disease; Dicumarol; Heart Defects, Congenital; Heart Valve Diseases; Intracranial Arteriosclerosis; Phlebitis; Pulmonary Emphysema; Thromboembolism; Toxicology; Vascular Diseases; Warfarin