Association between the vertebrobasilar artery geometry and basilar artery plaques determined by high-resolution magnetic resonance imaging

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Abstract

Background

Atherosclerotic plaques are often present in regions of arteries with complicated flow patterns. Vascular morphology plays important role in hemodynamics. In this study, we investigated the relationship between the geometry of the vertebrobasilar artery system and presence of basilar artery (BA) plaque.

Methods

We enrolled 290 patients with posterior circulation ischemic stroke. We distinguished four configurations of the vertebrobasilar artery: Walking, Tuning Fork, Lambda, and No Confluence. Patients were divided into multi-bending (≥ 3 bends) and oligo-bending (< 3 bends) VA groups. The diameter of the vertebral artery (VA) and the number of bends in the intracranial VA segment were assessed using three-dimensional time-of-flight magnetic resonance angiography. High-resolution magnetic resonance imaging was used to evaluate BA plaques. Logistic regression models were used to determine the relationship between the geometry type and BA plaque prevalence.

Results

After adjusting for sex, age, body mass index ≥ 28, hypertension, and diabetes mellitus, the Walking, Lambda, and No Confluence geometries were associated with the presence of BA plaque (all p < 0.05). Patients with multi-bending VAs in both the Walking (20/28, 71.43% vs. 6/21, 28.57%, p = 0.003) and Lambda group (19/47, 40.43% vs. 21/97, 21.65%, p = 0.018) had more plaques compared to patients with oligo-bending VAs in these groups. In the Lambda group, the difference in diameter of bilateral VAs was larger in patients with BA plaques than that in patients without BA plaques (1.4 mm [IQR: 0.9–1.6 mm] vs. 0.9 mm [IQR: 0.6–1.3 mm], p < 0.001).

Conclusions

The Walking, Lambda, and No Confluence geometry, ≥ 3 bends in the VAs, and a large diameter difference between bilateral VAs are associated with the presence of BA plaque.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12868-021-00624-5.

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Most cited references 22

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A prospective natural-history study of coronary atherosclerosis.

Gregg W. Stone, Akiko Maehara, Alexandra J. Lansky … (2011)

Atherosclerotic plaques that lead to acute coronary syndromes often occur at sites of angiographically mild coronary-artery stenosis. Lesion-related risk factors for such events are poorly understood. In a prospective study, 697 patients with acute coronary syndromes underwent three-vessel coronary angiography and gray-scale and radiofrequency intravascular ultrasonographic imaging after percutaneous coronary intervention. Subsequent major adverse cardiovascular events (death from cardiac causes, cardiac arrest, myocardial infarction, or rehospitalization due to unstable or progressive angina) were adjudicated to be related to either originally treated (culprit) lesions or untreated (nonculprit) lesions. The median follow-up period was 3.4 years. The 3-year cumulative rate of major adverse cardiovascular events was 20.4%. Events were adjudicated to be related to culprit lesions in 12.9% of patients and to nonculprit lesions in 11.6%. Most nonculprit lesions responsible for follow-up events were angiographically mild at baseline (mean [±SD] diameter stenosis, 32.3±20.6%). However, on multivariate analysis, nonculprit lesions associated with recurrent events were more likely than those not associated with recurrent events to be characterized by a plaque burden of 70% or greater (hazard ratio, 5.03; 95% confidence interval [CI], 2.51 to 10.11; P<0.001) or a minimal luminal area of 4.0 mm(2) or less (hazard ratio, 3.21; 95% CI, 1.61 to 6.42; P=0.001) or to be classified on the basis of radiofrequency intravascular ultrasonography as thin-cap fibroatheromas (hazard ratio, 3.35; 95% CI, 1.77 to 6.36; P<0.001). In patients who presented with an acute coronary syndrome and underwent percutaneous coronary intervention, major adverse cardiovascular events occurring during follow-up were equally attributable to recurrence at the site of culprit lesions and to nonculprit lesions. Although nonculprit lesions that were responsible for unanticipated events were frequently angiographically mild, most were thin-cap fibroatheromas or were characterized by a large plaque burden, a small luminal area, or some combination of these characteristics, as determined by gray-scale and radiofrequency intravascular ultrasonography. (Funded by Abbott Vascular and Volcano; ClinicalTrials.gov number, NCT00180466.).

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Hemodynamic shear stress and its role in atherosclerosis.

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Atherosclerosis, the leading cause of death in the developed world and nearly the leading cause in the developing world, is associated with systemic risk factors including hypertension, smoking, hyperlipidemia, and diabetes mellitus, among others. Nonetheless, atherosclerosis remains a geometrically focal disease, preferentially affecting the outer edges of vessel bifurcations. In these predisposed areas, hemodynamic shear stress, the frictional force acting on the endothelial cell surface as a result of blood flow, is weaker than in protected regions. Studies have identified hemodynamic shear stress as an important determinant of endothelial function and phenotype. Arterial-level shear stress (>15 dyne/cm2) induces endothelial quiescence and an atheroprotective gene expression profile, while low shear stress (<4 dyne/cm2), which is prevalent at atherosclerosis-prone sites, stimulates an atherogenic phenotype. The functional regulation of the endothelium by local hemodynamic shear stress provides a model for understanding the focal propensity of atherosclerosis in the setting of systemic factors and may help guide future therapeutic strategies.

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Large artery intracranial occlusive disease: a large worldwide burden but a relatively neglected frontier.

Philip B Gorelick, Ka Sing Wong, Hee-Joon Bae … (2008)

Large artery intracranial occlusive disease (LAICOD) is a common and important stroke subtype. In this commentary, we review key epidemiological aspects of LAICOD. LAICOD has emerged as the most common stroke subtype worldwide and is associated with a high risk of recurrent stroke. Hypotheses have been proposed to explain causation, which include such factors as traditional cardiovascular risk factors, high blood volume states, and genetic abnormalities. Approaches to treatment such as antithrombotic therapies, revascularization procedures, and counterpulsation devices hold promise. LAICOD poses a major stroke problem worldwide and is likely the most common stroke subtype. The etiology and treatment of this disorder remain poorly defined. International collaborations are needed to pool collective knowledge and develop definitive studies to better understand causation and treatment of LAICOD.

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Author and article information

Contributors

Yunjing Xue: xueyunjing@126.com

Journal

Journal ID (nlm-ta): BMC Neurosci

Journal ID (iso-abbrev): BMC Neurosci

Title: BMC Neuroscience

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2202

Publication date (Electronic): 25 March 2021

Publication date PMC-release: 25 March 2021

Publication date Collection: 2021

Volume: 22

Electronic Location Identifier: 20

Affiliations

[1 ]GRID grid.411176.4, ISNI 0000 0004 1758 0478, Department of Radiology, , Fujian Medical University Union Hospital, ; Fuzhou, 350001 Fujian China

[2 ]Department of Radiology, Changle District Hospital of Fuzhou, Fuzhou, 350299 Fujian China

[3 ]GRID grid.12527.33, ISNI 0000 0001 0662 3178, Center for Biomedical Imaging Research, Department of Biomedical Engineering, , Tsinghua University School of Medicine, ; Beijing, 100084 China

Article

Publisher ID: 624

DOI: 10.1186/s12868-021-00624-5

PMC ID: 7992992

PubMed ID: 33765922

SO-VID: 2abcba82-8411-467a-a790-3b205d33d767

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 2 December 2020

Date accepted : 9 March 2021

Custom metadata

ScienceOpen disciplines: Neurosciences

Keywords: atherosclerosis,intracranial artery,magnetic resonance imaging,geometry,vertebrobasilar

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ScienceOpen disciplines: Neurosciences

Keywords: atherosclerosis, intracranial artery, magnetic resonance imaging, geometry, vertebrobasilar

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Association between the vertebrobasilar artery geometry and basilar artery plaques determined by high-resolution magnetic resonance imaging

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Abstract

Background

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Results

Conclusions

Supplementary Information

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Karger: Neurology and Neuroscience

Most cited references 22

A prospective natural-history study of coronary atherosclerosis.

Hemodynamic shear stress and its role in atherosclerosis.

Large artery intracranial occlusive disease: a large worldwide burden but a relatively neglected frontier.

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Cited by 6

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