Possible Morphological Pathomechanisms of Ischemic Stroke in the Posterior Circulation of Patients with Vertebral Artery Hypoplasia

2014 ◽  
Vol 25 (3) ◽  
pp. 408-414 ◽  
Author(s):  
Andrea Skultéty Szárazová ◽  
Eva Bartels ◽  
Susanne Bartels ◽  
Peter Turčáni
Keyword(s):  
Ischemic Stroke ◽  
Vertebral Artery ◽  
Posterior Circulation ◽  
Vertebral Artery Hypoplasia

Abstract T P103: Vertebral Artery Hypoplasia Should Play Important Role for Posterior Circulation Ischemia

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Hidetaka Mitsumura ◽  
Teppei Komatsu ◽  
Shinji Miyagawa ◽  
Yuki Sakamoto ◽  
Toshiaki Hirai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Vertebral Artery ◽  
Prevalence Rate ◽  
Odds Ratio ◽  
Multivariate Regression ◽  
Posterior Circulation ◽  
Large Artery ◽  
Carotid Ultrasonography ◽  
Vertebral Artery Hypoplasia

Purpose: Vertebral artery hypoplasia (VAH) is congenital anatomical variation, which is frequently observed in clinical situation. In previous reports, it was not unclear whether VAH was the independent risk factor for posterior circulation ischemia. The purpose of this study is to evaluate an impact of VAH on posterior circulation ischemia. Methods: Subjects were patients with acute ischemic stroke who underwent brain MRI and carotid ultrasonography. The diameter of vessel and flow velocities of extracranial vertebral artery (VA) was measured by carotid ultrasonography. Diagnostic criteria of VAH was as follows: 1) diameter of VA <2.5mm, 2) diameter of VA <3.0mm and a side difference equal or greater than 1:1.7, 3) diameter of VA <3.0mm, peak systolic velocity <40cm/sec, and resistance index value >0.75. We divided all patients into three groups by the location of the acute ischemic stroke evaluated by MRI: ischemic lesion on posterior circulation (P group), on anterior circulation (A group), and multiple lesions on both anterior and posterior circulation (AP group). Then, the prevalence rate of VAH was compared between P group and A+AP group. In order to evaluate independent factors of VA occlusion, we conducted multivariate regression analyses. Results: We evaluated a total of 129 consecutive patients (87 male, median age; 71 years). P group was 36 patients, and A+AP group was 93 patients. VAH was seen in 39 patients (31.5%), and VA occlusion was found in 15 patients. The prevalence rate of VAH in P group (44.4%) was significantly higher than in A+AP group (24.7%, p=0.034). In univariate analysis, the patients with VA occlusion were higher rates of hypertension (p=0.066), large artery atherosclerosis (p=0.095), posterior circulation ischemia (p=0.001), and the presence of VAH (p=0.038). Multivariate regression analysis demonstrated that large artery atherosclerosis (odds ratio, 6.3; 95% confidence interval, 1.3-30.1), posterior circulation ischemia (odds ratio, 12.0; 95% confidence interval, 2.8-51.2) and VAH (odds ratio, 4.2; 95% confidence interval, 1.2-15.0) were independently associated with the presence of VA occlusion. Conclusion: VAH was independent factor of VA occlusion, and should be associated with posterior circulation ischemia.

scholarly journals Vertebral artery hypoplasia as an independent risk factor of posterior circulation atherosclerosis and ischemic stroke

Medicine ◽  
2021 ◽  
Vol 100 (38) ◽  
pp. e27280
Author(s):  
Yasemin Dinç ◽  
Rifat Özpar ◽  
Büşra Emir ◽  
Bahattin Hakyemez ◽  
Mustafa Bakar
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Vertebral Artery ◽  
Independent Risk Factor ◽  
Posterior Circulation ◽  
Vertebral Artery Hypoplasia

Relationship between Vertebral Artery Hypoplasia and Posterior Circulation Ischemia

2016 ◽  
Vol 25 (2) ◽  
pp. 266-269 ◽  
Author(s):  
Hidetaka Mitsumura ◽  
Shinji Miyagawa ◽  
Teppei Komatsu ◽  
Toshiaki Hirai ◽  
Yu Kono ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Circulation ◽  
Vertebral Artery Hypoplasia

scholarly journals Vertebral Artery Ostium Atherosclerotic Plaque as a Potential Source of Posterior Circulation Ischemic Stroke

Stroke ◽  
2011 ◽  
Vol 42 (9) ◽  
pp. 2544-2549 ◽  
Author(s):  
Firas Al-Ali ◽  
Tom Barrow ◽  
Li Duan ◽  
Anne Jefferson ◽  
Susan Louis ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Vertebral Artery ◽  
Atherosclerotic Plaque ◽  
Posterior Circulation ◽  
Potential Source

Abstract TP84: Prognostic Factor of Intracranial Vertebral Artery Dissection: High Resolution Vessel Wall Magnetic Resonance Imaging Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jae-Hwan Kim ◽  
Hyung Jun Kim ◽  
Ye Sel Kim ◽  
Woo-Keun Seo ◽  
Oh Young Bang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Resolution ◽  
Prognostic Factor ◽  
Vertebral Artery ◽  
Vessel Wall ◽  
Independent Predictor ◽  
Vertebral Artery Dissection ◽  
Posterior Circulation ◽  
Artery Dissection ◽  
Poor Outcomes

Background: Vertebral artery dissection (VAD) is well recognized cause of stroke in young and middle aged individuals. But, prognostic factor of posterior circulation ischemic stroke or transient ischemic attack (TIA) caused by intracranial VAD has been rarely discussed. Our aim was to evaluate the predictors of poor outcomes in posterior circulation ischemic stroke caused by intracranial VAD. Methods: We retrospectively reviewed patients with posterior circulation ischemic stroke or TIA caused by intracranial VAD using high-resolution vessel wall MRI who were recruited from Samsung Medical Center Stroke Registry (between January 1, 2011 and April 30, 2019). Poor outcomes were defined as a 3-months modified Rankin scale (mRS) score ≥ 2. Results: We registered 96 patients (74 males; mean age, 58.9±14.2 years) with acute posterior circulation ischemic stroke or TIA caused by intracranial VAD. Trauma history associated with VAD was presented in 23 (24%) of patients. Headache and neck pain around neurological symptom onset were presented in 41 (42.7%) and 19 (19.8%) of patients, respectively. Dissecting aneurysm, bilateral vertebral artery involvement, basilar artery involvement and wall hematoma with dissection were presented in 26 (27.1%), 26 (27.1%), 12 (12.5%) and 66 (68.8%) of patients, respectively. Of the 96 VADs, 26 (27.1%) presented with focal stenosis, 21 (21.9%) with multifocal stenosis, and 57 (59.4%) with occlusion. Lateral medulla involvement and multiple territory involvement were presented in 35 (36.5%) and 31 (32.3%) of patients. Recurrence rate of ischemic stroke or TIA within 90 days of symptom onset was 6.25%. Twenty-nine patients (30.2%) had poor outcomes at 3 months. Lateral medulla involvement was an independent predictor for poor outcome (odds ratio=3.293, 95% confidence interval=1.301-8.333, p=0.012). Conclusion: Posterior circulation ischemic stroke or TIA caused by intracranial VAD is associated with relatively benign clinical course. But the presence of lateral medulla involvement is independent predictor for poor outcome. Patients presenting lateral medullary infarction caused by intracranial VAD should be monitored closely.

Relationship between vertebral artery hypoplasia and posterior circulation stroke in Chinese patients

2012 ◽  
Vol 55 (3) ◽  
pp. 291-295 ◽  
Author(s):  
Xiao-Yue Hu ◽  
Zheng-Xi Li ◽  
Hui-Qin Liu ◽  
Min Zhang ◽  
Meng-Li Wei ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Circulation ◽  
Chinese Patients ◽  
Posterior Circulation Stroke ◽  
Vertebral Artery Hypoplasia

scholarly journals Increased risk for posterior circulation ischaemia in patients with vertebral artery hypoplasia: A systematic review and meta-analysis

2017 ◽  
Vol 2 (2) ◽  
pp. 171-177
Author(s):  
Aristeidis H Katsanos ◽  
Sotirios Giannopoulos
Keyword(s):  
Systematic Review ◽  
Observational Study ◽  
Vertebral Artery ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Posterior Circulation ◽  
Anterior Circulation ◽  
Study Protocols ◽  
Increased Risk ◽  
Vertebral Artery Hypoplasia

Introduction Although several study protocols reported that vertebral artery hypoplasia can predispose to posterior circulation ischaemia, the role of vertebral artery hypoplasia in the risk of posterior circulation ischaemia still remains controversial. The aim of the present meta-analysis was to investigate the association of vertebral artery hypoplasia and posterior circulation ischaemia. Patients and methods We performed a systematic review and random effects meta-analysis of all eligible observational study protocols reporting prevalence rates of vertebral artery hypoplasia in patients with anterior circulation ischaemia and posterior circulation ischaemia. Results We identified eight study protocols including a total of 3875 acute ischemic stroke patients (mean age: 64.2 years, 61.3% males) and reporting a pooled prevalence of vertebral artery hypoplasia 18.6% (95%CI: 10.8–30.0%). In the overall analysis, a significantly higher probability of vertebral artery hypoplasia presence was found in posterior circulation ischaemia patients compared to patients with anterior circulation ischaemia (risk ratio = 2.12, 95%CI: 1.60–2.82, p < 0.001). In the subsequent sensitivity analysis, vertebral artery hypoplasia was again found to be significantly more prevalent in patients with posterior circulation ischaemia compared to anterior circulation ischaemia (risk ratio = 1.81, 95%CI: 1.58–2.06, p < 0.001), with no evidence of heterogeneity (I2 = 0%, p for Cochran Q = 0.55) between included studies. Discussion The present report is a meta-analysis of retrospective observational study protocols, with all the inherent limitations of included studies. The heterogeneity on the reported rates of vertebral artery hypoplasia could be attributed to differences in population age, sex, race, imaging protocols and vertebral artery hypoplasia definition between included studies. Conclusion Our meta-analysis provides further evidence for a possible causal relationship between vertebral artery hypoplasia and cryptogenic posterior circulation ischaemia, an association which undoubtedly deserves further investigation in future prospective study protocols.

scholarly journals Association between vertebral artery hypoplasia and posterior circulation stroke

BMC Neurology ◽  
2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Virginija Gaigalaite ◽  
Augenijus Vilimas ◽  
Violeta Ozeraitiene ◽  
Jurate Dementaviciene ◽  
Ricardas Janilionis ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Circulation ◽  
Posterior Circulation Stroke ◽  
Vertebral Artery Hypoplasia

scholarly journals Medical and Interventional Therapy for Spontaneous Vertebral Artery Dissection in the Craniocervical Segment

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Guiyun Zhang ◽  
Zuoquan Chen
Keyword(s):  
Ischemic Stroke ◽  
Vertebral Artery ◽  
Conservative Therapy ◽  
Vertebral Artery Dissection ◽  
Clinical Manifestations ◽  
Interventional Therapy ◽  
Posterior Circulation ◽  
Artery Dissection ◽  
Stroke In The Young ◽  
Ischemic Attack

Background and Purpose. Spontaneous vertebral artery dissection (SVAD) is an important reason for posterior-circulation-ischemic stroke in the young and middle-aged population. Although some previous reports reveal a favorable outcome with conservative therapy, it is still controversial in the treatment of SVAD in some specific patients. Herein, we present our 10 years of clinical experience for SVAD at this location. Material and Methods. 20 patients with 20 SVADs in V2 and V3 segments were retrospectively studied. Clinical manifestations and imageology materials were collected and analyzed. All the patients underwent anticoagulation except for one patient because of contraindication. 14 patients underwent Wingspan stents implantation with general anesthesia. Results. In our sample, ischemia (infarction or transient ischemic attack, TIA) was found in all the patients. Angiographic stenosis and dissection aneurysm were the most common findings in the segments mentioned above. 19 of the patients (95%) got the excellent imageological and clinical outcomes. Conclusions. According to our experience in this group, although anticoagulation is effective in vertebral artery dissection, interventional therapy for SVADs in V2 and/or V3 segments is preferred in some specific patients. Stent with higher radial supporting and flexibility, such as Wingspan stent, is suggested.

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