Vertebral Artery Stenoses Contribute to the Development of Diffuse Plaques in the Basilar Artery.

Yundi Feng,Yajun E,Wenxi Zhang,Jian Liu,Yunlong Huo,Wenchang Tan,Xiaoping Yin,Tingting Fan

doi:10.3389/fbioe.2020.00168

Abstract

Vertebral artery (VA) stenosis is relevant to a high early risk of recurrent stroke and basilar artery (BA) is the most common intracranial site of atherosclerotic lesions. It is important to show predictive risk factors for transient ischemic attack (TIA) or posterior infarctions. The aim of the study is to investigate morphometry and hemodynamics in intracranial vertebral and basilar arteries of health and diseased patients to enhance the risk assessment. Based on the geometrical model reconstructed from CTA images in 343 patients, a transient three-dimensional computational model was used to determine the hemodynamics. Patients were classified in symmetric, asymmetric, hypoplastic, and stenotic groups while patients in the stenotic group were divided into unilateral, bilateral, bifurcation, and tandem stenotic sub-groups. Patients in bilateral, bifurcation, and tandem stenotic sub-groups had significantly lower basilar artery diameters than other groups. Patients in the stenotic group had significantly higher surface area ratio (SAR) of high time-averaged wall shear stress gradient (TAWSSG) and higher incidence of TIAs or posterior infarctions than other groups while patients in the tandem stenotic sub-group had the highest values (SAR-TAWSSG of 57 ± 22% and TIAs or posterior infarction incidence of 54%). The high SAR-TAWSSG is predisposed to induce TIAs or posterior infarction.

Highlights

There is higher prevalence of intracranial vertebrobasilar atherosclerosis in Asians than Caucasians (Caplan et al, 2004; Lee et al, 2006; Nouh et al, 2014)
Vertebral artery (VA) stenosis is relevant to a high early risk of recurrent stroke while basilar artery (BA) is the most common intracranial site of atherosclerotic lesions (Mattle et al, 2011; Markus et al, 2013; Qureshi and Caplan, 2014)
Based on the cardiovascular disease risk factors, patients are classified as hypertension, diabetes mellitus, smoking, and dyslipidemia groups, where a patient with multiple diseases is classified to different groups

Summary

Introduction

There is higher prevalence of intracranial vertebrobasilar atherosclerosis in Asians than Caucasians (Caplan et al, 2004; Lee et al, 2006; Nouh et al, 2014). Vertebral artery (VA) stenosis is relevant to a high early risk of recurrent stroke while basilar artery (BA) is the most common intracranial site of atherosclerotic lesions (Mattle et al, 2011; Markus et al, 2013; Qureshi and Caplan, 2014). In the intracranial vertebrobasilar arteries, the upstream stenoses in vertebral arteries or flow confluence (left and right vertebral arteries merging into the basilar artery) can significantly affect the hemodynamics in the distal basilar artery. We hypothesize that two-sided vertebral artery stenoses (including a stenosis at each vertebral artery and multiple stenoses in both vertebral arteries) or bifurcation stenoses at the flow confluence can be risk factors to accelerate the development of diffuse basilar artery lesions (i.e., the widespread disease in the basilar artery that can increase plaque burdens)

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