Abstract
BackgroundAtherosclerotic 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.MethodsWe 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.ResultsAfter 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).ConclusionsThe 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.
Highlights
Atherosclerotic plaques are often present in regions of arteries with complicated flow patterns
This study aimed to explore the potential association between the presence of basilar artery (BA) plaques and different vertebrobasilar geometries using high-resolution magnetic resonance imaging (HRMRI) in vivo
Of all 290 patients, 49 patients were in the Walking group, 73 patients were in the Tuning Fork group, 144 patients were in the Lambda group, and the last 24 patients were in the No Confluence group
Summary
Atherosclerotic plaques are often present in regions of arteries with complicated flow patterns. We investigated the relationship between the geometry of the vertebrobasilar artery system and presence of basilar artery (BA) plaque. Several recent studies have confirmed the feasibility of using high-resolution magnetic resonance imaging (HRMRI) to evaluate intracranial arterial atherosclerosis [9, 10]. Most of studies mainly focused on the relationship between plaque distribution, plaque enhancement, arterial remodeling patterns, intraplaque hemorrhage, and clinical ischemic events [11,12,13,14]. There is limited research that investigates the association between the vascular geometry and the plaque prevalence in posterior circulation using magnetic resonance imaging. WakeBuck et al [17] described the relationship between vertebrobasilar geometry and differences in hemodynamic distribution. Atherosclerotic plaques often develop in regions with low wall shear stress, such as the inner wall of a curved artery or the apex of a junction [18]
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