Hemodynamic Features of Symptomatic Vertebrobasilar Disease
Sepideh Amin-Hanjani, Xinjian Du, Linda Rose-Finnell, Dilip K Pandey, DeJuran Richardson, Keith R Thulborn, Mitchell S V Elkind, Gregory J Zipfel, David S Liebeskind, Frank L Silver, Scott E Kasner, Victor A Aletich, Louis R Caplan, Colin P Derdeyn, Philip B Gorelick, Fady T Charbel, VERiTAS Study Group, Hui Xie, Michael P Flannery, Hagai Ganin, Sean Ruland, Rebecca Grysiewicz, Aslam Khaja, Laura Pedelty, Fernando Testai, Archie Ong, Noam Epstein, Hurmina Muqtadar, Karriem Watson, Nada Mlinarevich, Maureen Hillmann, Joy Hirsch, Stephen Dashnaw, Philip M Meyers, Josh Z Willey, Edwina McNeill-Simaan, Veronica Perez, Alberto Canaan, Wayna Paulino-Hernandez, Katie Vo, Glenn Foster, Andria Ford, Abdullah Nassief, Abbie Bradley, Jannie Serna-Northway, Kristi Kraus, Lina Shiwani, Nancy Hantler, Jeffrey Alger, Sergio Godinez, Jeffrey L Saver, Latisha Ali, Doojin Kim, Matthew Tenser, Michael Froehler, Radoslav Raychev, Sarah Song, Bruce Ovbiagele, Hermelinda Abcede, Peter Adamczyk, Neal Rao, Anil Yallapragada, Royya Modir, Jason Hinman, Aaron Tansy, Mateo Calderon-Arnulphi, Sunil Sheth, Alireza Noorian, Kwan Ng, Conrad Liang, Jignesh Gadhia, Hannah Smith, Gilda Avila, Johanna Avelar, David Mikulis, Jorn Fierstra, Eugen Hlasny, Leanne K Casaubon, Mervyn Vergouwen, J C Martin Del Campo, Cheryl S Jaigobin, Cherissa Astorga, Libby Kalman, Jeffrey Kramer, Susan Vaughan, Laura Owens, Brett Kissela, Tanya N Turan, Tom P Jacobs, Scott Janis, Sepideh Amin-Hanjani, Xinjian Du, Linda Rose-Finnell, Dilip K Pandey, DeJuran Richardson, Keith R Thulborn, Mitchell S V Elkind, Gregory J Zipfel, David S Liebeskind, Frank L Silver, Scott E Kasner, Victor A Aletich, Louis R Caplan, Colin P Derdeyn, Philip B Gorelick, Fady T Charbel, VERiTAS Study Group, Hui Xie, Michael P Flannery, Hagai Ganin, Sean Ruland, Rebecca Grysiewicz, Aslam Khaja, Laura Pedelty, Fernando Testai, Archie Ong, Noam Epstein, Hurmina Muqtadar, Karriem Watson, Nada Mlinarevich, Maureen Hillmann, Joy Hirsch, Stephen Dashnaw, Philip M Meyers, Josh Z Willey, Edwina McNeill-Simaan, Veronica Perez, Alberto Canaan, Wayna Paulino-Hernandez, Katie Vo, Glenn Foster, Andria Ford, Abdullah Nassief, Abbie Bradley, Jannie Serna-Northway, Kristi Kraus, Lina Shiwani, Nancy Hantler, Jeffrey Alger, Sergio Godinez, Jeffrey L Saver, Latisha Ali, Doojin Kim, Matthew Tenser, Michael Froehler, Radoslav Raychev, Sarah Song, Bruce Ovbiagele, Hermelinda Abcede, Peter Adamczyk, Neal Rao, Anil Yallapragada, Royya Modir, Jason Hinman, Aaron Tansy, Mateo Calderon-Arnulphi, Sunil Sheth, Alireza Noorian, Kwan Ng, Conrad Liang, Jignesh Gadhia, Hannah Smith, Gilda Avila, Johanna Avelar, David Mikulis, Jorn Fierstra, Eugen Hlasny, Leanne K Casaubon, Mervyn Vergouwen, J C Martin Del Campo, Cheryl S Jaigobin, Cherissa Astorga, Libby Kalman, Jeffrey Kramer, Susan Vaughan, Laura Owens, Brett Kissela, Tanya N Turan, Tom P Jacobs, Scott Janis
Abstract
Background and purpose: Atherosclerotic vertebrobasilar disease is an important cause of posterior circulation stroke. To examine the role of hemodynamic compromise, a prospective multicenter study, Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS), was conducted. Here, we report clinical features and vessel flow measurements from the study cohort.
Methods: Patients with recent vertebrobasilar transient ischemic attack or stroke and ≥50% atherosclerotic stenosis or occlusion in vertebral or basilar arteries (BA) were enrolled. Large-vessel flow in the vertebrobasilar territory was assessed using quantitative MRA.
Results: The cohort (n=72; 44% women) had a mean age of 65.6 years; 72% presented with ischemic stroke. Hypertension (93%) and hyperlipidemia (81%) were the most prevalent vascular risk factors. BA flows correlated negatively with percentage stenosis in the affected vessel and positively to the minimal diameter at the stenosis site (P<0.01). A relative threshold effect was evident, with flows dropping most significantly with ≥80% stenosis/occlusion (P<0.05). Tandem disease involving the BA and either/both vertebral arteries had the greatest negative impact on immediate downstream flow in the BA (43 mL/min versus 71 mL/min; P=0.01). Distal flow status assessment, based on an algorithm incorporating collateral flow by examining distal vessels (BA and posterior cerebral arteries), correlated neither with multifocality of disease nor with severity of the maximal stenosis.
Conclusions: Flow in stenotic posterior circulation vessels correlates with residual diameter and drops significantly with tandem disease. However, distal flow status, incorporating collateral capacity, is not well predicted by the severity or location of the disease.
Keywords: magnetic resonance angiography; magnetic resonance imaging; regional blood flow; stroke; vertebrobasilar ischemia.
© 2015 American Heart Association, Inc.
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Source: PubMed