The Association of Vertebrobasilar System Morphology and Geometry with the Posterior and Anterior Ischemic Stroke
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https://doi.org/10.58600/eurjther2752Keywords:
Vertebrobasilar system, Hypoplasia, Posterior circulation stroke, Anterior circulation stroke, Computed tomography angiographyAbstract
Objective: Morphometric and geometric variations in the vertebrobasilar system (VBS) may influence cerebral hemodynamics, potentially contributing to ischemic strokes in both anterior and posterior circulatory territories. This study aimed to investigate the association between VBS morphology and ischemic stroke localization.
Methods: This retrospective observational study analyzed multidetector computed tomography angiography images from 431 patients (187 females, 244 males, mean age: 65.3 ± 14.6 years). Patients were categorized into three groups: anterior circulation ischemic stroke (ACIS, n=184), posterior circulation ischemic stroke (PCIS, n=88), and control subjects (n=159). Morphometric parameters were assessed using 3D Slicer software.
Results: Significant differences in basilar artery (BA) length were observed between stroke groups and controls, with ACIS and PCIS groups exhibiting longer BA lengths (p<0.05). Males had significantly longer vertebral artery (VA) lengths than females in the control and ACIS groups (p value < 0.05). The vertebrobasilar junction angle was significantly wider in females than in males (p value = 0.046). BA bending was predominantly directed to the right across all groups, with no significant differences between the stroke and control groups. VA dominance was more frequent on the left in ACIS and the right in PCIS, while VA hypoplasia was less common in stroke patients compared to controls, contrary to previous reports.
Conclusion: While certain morphometric and geometric variations in the VBS were observed, the evidence for a direct association between these characteristics and the localization of ischemic stroke was limited and inconclusive. These findings suggest that vertebrobasilar morphology may not independently determine stroke localization.
References
Madonis SM, Jenkins JS. (2021) Vertebral artery stenosis. Prog Cardiovasc Dis. 65:55-59. https://doi.org/10.1016/j.pcad.2021.02.006
Songur A, Gonul Y, Ozen OA, Kucuker H, Uzun I, Bas O, Toktas M. et al. (2008) Variations in the intracranial vertebrobasilar system. Surg Radiol Anat. 30(3):257-264. https://doi.org/10.1007/s00276-008-0309-6
Sharifi A, Salari A, Taebi A, Niazmand H, Niazmand MJ. (2017) Flow Patterns and Wall Shear Stress Distribution in Human Vertebrobasilar System: A Computational Study to Investigate Smoking Effects on Atherosclerotic Stenosis at Different Ages. Proceedings of the ASME 2017 International Mechanical Engineering Congress and Exposition. Volume 3: Biomedical and Biotechnology Engineering. Tampa, Florida, USA. 3–9. V003T04A017. ASME. https://doi.org/10.1115/IMECE2017-70555
De Caro J, Ciacciarelli A, Tessitore A, Buonomo O, Calzoni A, et al. (2021) Variants of the circle of Willis in ischemic stroke patients. J Neurol. 268(10):3799-3807. https://doi.org/10.1007/s00415-021-10454-4
Akkasoglu S, Aldur M, Sargon M, Celebioglu EC, Caliskan S. (2019) Morphometry and geometry of the formation of basilar artery. Med-Science. 8(4):980-985. https://doi.org/10.5455/medscience.2019.08.9076
Ogeng’o JA, Mwachaka PM, Odhiambo DE, Sinkeet SR, Elbusaidy H, et al. (2018). Geometric features of vertebrobasilar arterial system in adult Black Kenyans. International Journal of Morphology. 36(2): 544–550. https://doi.org/10.4067/S0717-95022018000200544
Ravensbergen J, Ravensbergen JW, Krijger JK, Hillen B, Hoogstraten HW. (1998) Localizing role of hemodynamics in atherosclerosis in several human vertebrobasilar junction geometries. Arterioscler Thromb Vasc Biol. 18(5):708-716. https://doi.org/10.1161/01.atv.18.5.708
Ravensbergen J, Krijger JK, Hillen B, Hoogstraten HW. (1996) The influence of the angle of confluence on the flow in a vertebro-basilar junction model. J Biomech. 29(3):281-299. https://doi.org/10.1016/0021-9290(95)00064-x
Anirudh EE, Omotoso BR, Lazarus L. (2022) Radiological anatomy of the vertebrobasilar artery in a select South African population. Translational Research in Anatomy. 27:100205. https://doi.org/10.1016/j.tria.2022.100205
Hori S, Hori E, Umemura K, Shibata T, Okamoto S, et al. (2020) Anatomical Variations of Vertebrobasilar Artery are Closely Related to the Occurrence of Vertebral Artery Dissection-An MR Angiography Study. J Stroke Cerebrovasc Dis. 29(4):104636. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104636
Park JH, Kim JM, Roh JK. (2007) Hypoplastic vertebral artery: frequency and associations with ischaemic stroke territory. J Neurol Neurosurg Psychiatry. 78(9):954-958. https://doi.org/10.1136/jnnp.2006.105767
Ngo MT, Kwak HS, Chung GH. (2020) Change in basilar artery length and bending according to aging and vertebral artery dominance: A longitudinal study. Sci Rep. 10(1):1-8. https://doi.org/10.1038/s41598-020-65682-x
Szalontai L, Jokkel Z, Horvath T, Piroska M, Forgo B, et al. (2021) Are the Morphological Indices of the Vertebrobasilar System Heritable? A Twin Study Based on 3D Reconstructed Models. Medicina (Kaunas). 57(2):127. https://doi.org/10.3390/medicina57020127
Hong JM, Chung CS, Bang OY, Yong SW, Joo IS, Huh K. (2009) Vertebral artery dominance contributes to basilar artery curvature and peri-vertebrobasilar junctional infarcts. J Neurol Neurosurg Psychiatry. 80(10):1087-1092. https://doi.org/10.1136/jnnp.2008.169805
Nishikata M, Hirashima Y, Tomita T, Futatsuya R, Horie Y, Endo S. (2004) Measurement of basilar artery bending and elongation by magnetic resonance cerebral angiography: relationship to age, sex and vertebral artery dominance. Arch Gerontol Geriatr. 38(3):251-259. https://doi.org/10.1016/j.archger.2003.10.006
Yu J, Zhang S, Li ML, Ma Y, Dong YR, et al. (2018) Relationship between the geometry patterns of vertebrobasilar artery and atherosclerosis. BMC Neurol. 18(1):83. https://doi.org/10.1186/s12883-018-1084-6.
Omotoso BR, Harrichandparsad R, Satyapal KS, Moodley IG, Lazarus L. (2021) Radiological anatomy of the intracranial vertebral artery in a select South African cohort of patients. Sci Rep. 11(1):12138. https://doi.org/10.1038/s41598-021-91744-9
Dzierżanowski J, Szarmach A, Baścik B, Czapiewski P, Muc A, et al. (2017) Intracranial region of the vertebral artery: morphometric study in the context of clinical usefulness. Folia Morphol (Warsz). 76(3):379-387. https://doi.org/10.5603/FM.a2017.0021
Han HC. (2012) Twisted blood vessels: symptoms, etiology and biomechanical mechanisms. J Vasc Res. 49(3):185-197. https://doi.org/10.1159/000335123
Zheng J, Sun B, Lin R, Teng Y, Zhao X, Xue Y. (2021) Association between the vertebrobasilar artery geometry and basilar artery plaques determined by high-resolution magnetic resonance imaging. BMC Neurosci. 22(1):20. https://doi.org/10.1186/s12868-021-00624-5
Zhang DP, Peng YF, Zhang HL, Ma JG, Zhao M, et al. (2019) Basilar Artery Tortuosity Is Associated with White Matter Hyperintensities by TIMP-1. Front Neurosci. 13:836. https://doi.org/10.3389/fnins.2019.00836
Zhang DP, Zhang SL, Zhang JW, Zhang HT, Fu SQ, et al. (2014) Basilar artery bending length, vascular risk factors, and pontine infarction. J Neurol Sci. 338(1-2):142-147. https://doi.org/10.1016/j.jns.2013.12.037
Ballesteros L, Forero P, Quintero I. (2013). Morphological expression of the anterior spinal artery and the intracranial segment of the vertebral artery: A direct anatomic study. Romanian Journal of Morphology and Embryology. 54(3):513–518.
Dharshini P, Raghunath G, Gurusamy K, Begum Z, Dhamodaran S, et al. (2022) Morphometric Study of the Intracranial Segment of the Vertebral Artery. Cureus. 14(2): e22137. https://doi.org/10.7759/cureus.22137
Zhu W, Wang YF, Dong XF, Feng HX, Zhao HQ, Liu CF. (2016) Study on the correlation of vertebral artery dominance, basilar artery curvature and posterior circulation infarction. Acta Neurol Belg. 116(3):287-293. https://doi.org/10.1007/s13760-015-0570-5
Zurada A, St Gielecki J, Baron J, Zawiliński J, Kozłowska H. (2008) Interactive 3D stereoscopic digital-image analysis of the basilar artery bifurcation. Clin Anat. 21(2):127-137. https://doi.org/10.1002/ca.20598.
Tütüncü F, Schimansky S, Baharoglu MI, Gao B, Calnan D, et al. (2014) Widening of the basilar bifurcation angle: association with presence of intracranial aneurysm, age, and female sex. J Neurosurg. 121(6):1401-1410. https://doi.org/10.3171/2014.8.JNS1447
Zhang XJ, Gao BL, Li TX, Hao WL, Wu SS, Zhang DH. (2018) Association of Basilar Bifurcation Aneurysms with Age, Sex, and Bifurcation Geometry. Stroke. 49(6):1371-1376. https://doi.org/10.1161/STROKEAHA.118.020829
Gaigalaite V, Vilimas A, Ozeraitiene V, Dementaviciene J, Janilionis R, et al. (2016) Association between vertebral artery hypoplasia and posterior circulation stroke. BMC Neurol. 16:118. https://doi.org/10.1186/s12883-016-0644-x
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