Toward a Further Elucidation: Role of Vertebral Artery Hypoplasia in Acute Ischemic Stroke

Abstract

Background and Purpose: Congenital vertebral artery (VA) hypoplasia is an uncommon embryonic variation of posterior circulation. The frequency of this congenital variation was reported to be 2–6% from autopsy and angiograms. The aim of our study was to elucidate the role of VA hypoplasia in acute ischemic stroke. Method: We examined 191 acute ischemic stroke patients (age 55.8 ± 14.0 years). TOAST subtypes were determined. A cervical magnetic resonance angiogram was performed in every patient. A duplex study of bilateral VA with flow velocities and vessel diameter recording in the intertransverse (V2) segment was performed within 72 h after onset of ischemic stroke. The net VA flow volume was measured in each subject. Result: The overall incidence of a unilateral congenital hypoplastic VA was 11.51%, which was statistically higher especially in cases of brainstem/cerebellar infarction. Of these, subjects with VA hypoplasia had an etiological preponderance of the ‘large-artery atherosclerosis’ subtype and a topographic preponderance of ipsilateral posterior circulation infarction. Conclusions: Based on our results, VA hypoplasia seemed a contributing factor of acute ischemic stroke, especially in posterior circulation territories.