Abstract WP228: Vertebral Artery Configuration as a Risk Factor for Dissection in Children

Abstract

Introduction: Arterial ischemic strokes are estimated to occur in 1.2 to 8 per 100,000 children per year with 15-22% occurring in the posterior circulation. Vertebral artery dissection(VAD) is a known cause of posterior circulation ischemic stroke in approx 7% of cases. Pediatric Bow Hunter syndrome, usually presents distinctively with VAD and stroke. It most commonly involves the V3 segment. In 2021, Braga et all proposed a new protocol for management for children with spontaneous VAD.They noted 2 different configurations of the vertebral artery. In this study we go on the explore these different configurations further and their role in spontaneous VAD. Aim & Hypothesis: Two configurations of the vertebral artery at the V3 segment were observed. Type A and Type B depending on the angle of curvature of the V3 segment. Type A config. is more linear with > 110 degree of angulation. Type B config. is angulated with 2 < 110 degree angles. We aim to investigate these configurations in patients without dissection vs those with vertebral artery dissection. We hypothesized that Type B configuration would be more prevalent in patients with spontaneous VAD. Methods: Retrospective chart review conducted at UTSW medical center. MRA/IR angiograms reviewed of 49 patients; 19 with spontaneous VAD and 30 with no vertebral pathology. Results: 79% of the total dissected vessels(19/24) had configuration Type B and 20.83%(5/24) had configuration Type A. In the control group of 30 patients with no VAD, TypeB was present in 25.4%(13/51) and configuration A in 74.5% (38/51). Type B configuration had a statistically significant higher prevalence in V3 dissection group. (p=<0.001) Conclusion: Type B configuration of the V3 segment would warrant further investigation in the right setting.