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P57 Most reports on basilar artery (BA) occlusive disease have  retrospectively described isolated cases or small series of patients,  focusing mainly on clinicoanatomical correlations. To assess the stroke  mechanisms, etiologies, clinical and vascular features, and outcome of  BA occlusive disease, we analyzed 76 patients (52 men, 24 women; mean  age: 62.1 yrs; range: 5 - 87 yrs) prospectively collected in the New  England Medical Center Posterior Circulation Stroke Registry between  November 1986 and February 1997, with a diagnosis of moderate  (50–70%) to severe (&gt;70%) BA stenosis or occlusion. Vascular  imaging was done by TCD, catheter angiography or MRA. BA stenosis was  found in 51 (67.1%) patients, while 25 (32.9%) had BA occlusion. Most  patients (60.5%) had involvement of the mid-portion of the BA. In  44.7% of patients, the occlusive disease was intrinsic to the BA, in  43.4% BA involvement was part of extensive atherosclerosis in the  posterior circulation, and 11.8% of patients had embolism to the BA  from the heart or proximal arteries. Fifty-two patients (68.4%) had  strokes, half preceded by TIAs. The remaining 24 patients presented  with TIAs only. The average duration of TIAs was 3.7 months, when  excluding 4 patients whose TIAs lasted over 8 yrs. When an infarct was  present, the middle posterior intracranial territory including the pons  and the anteroinferior cerebellum was most often involved (73.1%). The  etiology of the BA lesions was atherothrombotic in 77.6% and the  mechanism presumed hemodynamic in 73.7%. Hypertension (64.5%),  hyperlipidemia (40.8%) and coronary artery disease (35.5%) were the  most frequent risk factors. Among the 9 patients without risk factors,  3 had BA dissections and 2 had basilar migraine. Of patients with a BA  stenosis, 50% had no deficits at follow-up, whereas 75% of BA  occlusions lead to disability. Embolism to the BA had severe outcome,  with major disability or death occurring in 77.8% of patients. The  outcome was best in the patients with diffuse atherosclerotic disease.  Our data shows that studying the clinical and vascular features helps  understand the mechanism, etiology and determine outcome in BA  occlusive disease.

Basilar Artery Occlusive Disease in the New England Medical Center Posterior Circulation Stroke Registry