Ischemic stroke patterns and hemodynamic features in patients with small vertebrobasilar artery

• Published in: Journal of the neurological sciences 2009-12, Vol.287 (1), p.227-235
• Main Authors: Park, Jong-Ho, Roh, Jae-Kyu, Kwon, Hyung-Min
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angiography; Basilar Artery - abnormalities; Basilar Artery - physiopathology; Biological and medical sciences; Brain Stem - blood supply; Brain Stem - pathology; Brain Stem - physiopathology; Brain Stem Infarctions - etiology; Brain Stem Infarctions - pathology; Brain Stem Infarctions - physiopathology; Causality; Cerebellar Diseases - etiology; Cerebellar Diseases - pathology; Cerebellar Diseases - physiopathology; Cerebellum - blood supply; Cerebellum - pathology; Cerebellum - physiopathology; Cerebrovascular Circulation - physiology; Circle of Willis - abnormalities; Circle of Willis - physiopathology; Female; Hemodynamics - physiology; Humans; Ischemic pattern; Long circumferential artery; Magnetic Resonance Angiography - methods; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; MR imaging; Neurology; Severity of Illness Index; Small vertebrobasilar artery; Vascular diseases and vascular malformations of the nervous system; Vertebral Artery - abnormalities; Vertebral Artery - physiopathology; Vertebrobasilar Insufficiency - pathology; Vertebrobasilar Insufficiency - physiopathology
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2009.07.007

Abstract Background To determine the role of small vertebrobasilar artery (SVBA) in patients with posterior circulation stroke (PCS), we evaluated the ischemic patterns, collateral features, and stroke mechanisms in PCS patients with SVBA. Methods Ischemic findings on magnetic resonance (MR) imaging were correlated with 3D time-of-flight/contrast-enhanced MR angiography and/or catheter angiography in 18 patients (mean age, 68.0 ± 11.8 years; 9 males). SVBA (lumen diameter of < 3 mm) was compared with stenotic normal-sized VBA (NVBA) in 14 PCS patients. Results Ischemic lesions were predominantly observed in the cerebellum and/or medulla (vertebral artery (VA) territory). All subjects had fetal posterior circulation (FPC) from the internal carotid artery to the posterior cerebral artery. Sixteen patients (88.9%) had distal or diffuse VA stenosis/occlusion. In 14 patients (77.8%), long circumferential artery (LCA) was prominently observed. In atherothrombotic patients, infratentorial PCS might occur following artery-to-artery embolism from the low-flowed or stenotic VA to LCA. Ischemic patterns between subjects with and without VA disease were almost similar. As the degree of VA disease increased, the frequency of LCA prominence showed an increased tendency ( P = 0.003). Relatively small, scattered infarcts were observed in patients with SVBA than in those with stenotic NVBA. Conclusions FPC does not protect against infratentorial PCS. Regardless of extensive arterial lesions, relatively small infarcts may be due to previously established collaterals from the LCA, which could compensate for the defects in the infratentorial area.