Correlation between vascular stenosis severity and dizziness symptoms and neurological prognosis in elderly patients with acute ischemic stroke.

BACKGROUND

Dizziness is a frequent complaint among elderly patients with acute ischemic stroke. However, its association with different grades and locations of arterial stenosis remains unclear. This study aimed to assess the links between stenosis severity, posterior circulation involvement, dizziness, and short-term neurological outcomes.

METHODS

A retrospective analysis was performed on 134 elderly patients with acute ischemic stroke admitted from January 2024 to May 2025. All patients underwent Computed Tomography Angiography (CTA) or MRA of the intracranial and extracranial arteries, including the common and internal carotid arteries, the middle cerebral artery, the vertebral artery (VA), and the basilar artery (BA). Stenosis of extracranial segments was measured with North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, while intracranial segments were assessed using Warfarin-Aspirin Symptomatic Intracranial Disease Trial (WASID) standards. Patients were grouped by the most severely affected major supplying artery as mild (<50%), moderate (50-69%), or severe (≥70% or occlusion) stenosis. A separate vertebrobasilar artery (VA/BA) stenosis group included individuals with ≥50% stenosis of the vertebral or BA, regardless of anterior circulation status. Collected data included baseline characteristics, dizziness occurrence, Dizziness Handicap Inventory (DHI) scores, admission National Institutes of Health Stroke Scale (NIHSS) scores, and 3-month modified Rankin Scale (mRS) scores. Univariate and multivariate logistic regression analyses were conducted to identify risk factors.

RESULTS

The severe stenosis group and the VA/BA stenosis group showed higher dizziness rates than the other groups (44.9 and 50.0%, p < 0.01). Cerebellar and brainstem infarctions were more frequent in patients with VA/BA stenosis (83.3%), and these infarcts also appeared more often in the dizziness group (65.8% vs. 19.8%). Multivariate analysis indicated that VA/BA stenosis (OR = 3.42, 95% CI: 1.28-9.13) and posterior circulation infarction (OR = 4.51, 95% CI: 2.01-10.13) were independent factors related to dizziness. Severe stenosis (OR = 4.96) and VA/BA stenosis (OR = 3.18) were independently associated with functional dependence at 3 months (mRS ≥ 3). Admission NIHSS (OR = 1.42) and age (OR = 1.10) also suggested poorer outcomes.

CONCLUSION

In elderly patients with acute ischemic stroke, severe arterial stenosis and VA/BA stenosis were linked to higher risks of dizziness and 3-month functional dependence. Posterior circulation infarction markedly increased the likelihood of dizziness. Enhanced vascular imaging assessment and attention to symptoms such as dizziness may help identify high-risk individuals and support personalized management.