Vertebrobasilar Junction Angle Over 90°: A Potential Imaging Marker Associated With Vertebrobasilar Atherosclerosis.

Jia Li,Xiang-Yan Chen,Heng Du,Lu Zheng,Winnie Chiu-Wing Chu,Thomas Wai-Hong Leung,Wen-Jie Yang

doi:10.3389/fnins.2021.789852

Abstract

Objective: Whether the cerebral vascular variations play an important role in the progression of intracranial atherosclerosis is yet largely unclear. We aimed to investigate the relationship between the magnitude of the vertebrobasilar junction (VBJ) angle and the imaging features of vertebrobasilar artery atherosclerosis.Methods: Adult patients with acute ischemic stroke or transient ischemic attack undergoing a 3.0-tesla vessel wall magnetic resonance imaging (VW-MRI) scanning were consecutively included. Imaging features of vertebrobasilar artery atherosclerosis were assessed on the reconstructed short axis of VW-MRI at the most stenotic site. The VBJ angle degree was measured on magnetic resonance angiography and classified into the angle ≥90° or <90°.Results: Among 68 patients (mean age = 63.5 ± 9.4 years old; 63.2% were male) with vertebrobasilar atherosclerosis, 33 had a VBJ angle ≥90° and 35 had a VBJ angle <90°. Compared to the vertebrobasilar plaques with VBJ angle <90°, those with VBJ angle ≥90° had a heavier plaque burden (84.35 vs. 70.58%, p < 0.001) and higher prevalence of intraplaque hemorrhage (17.1 vs. 3.3%, p = 0.01). In the regression analyses, the VBJ angle ≥90° was also robustly associated with plaque burden (odds ratio, 1.11; 95% confidential interval, 1.043–1.18; p = 0.001) and intraplaque hemorrhage (odds ratio, 5.776; 95% confidential interval, 1.095–30.46; p = 0.039) of vertebrobasilar atherosclerosis.Conclusion: The VBJ angle over 90° might aggravate the vessel wall condition of the atherosclerotic vertebrobasilar arteries, which might serve as a potential risk factor for vertebrobasilar atherosclerosis.

Highlights

Ischemic stroke (IS) due to intracranial large artery atherosclerosis poses a major threat to the global public health and economy (Kaul et al, 2018; Kim et al, 2020; Wang et al, 2020)
A total of 68 patients with vertebrobasilar artery atherosclerosis were included in this study
The degrees of the vertebrobasilar junction (VBJ) angles varied from 29.45◦ to 124.20◦ in patients with vertebrobasilar atherosclerosis (Figure 3)

Summary

Introduction

Ischemic stroke (IS) due to intracranial large artery atherosclerosis poses a major threat to the global public health and economy (Kaul et al, 2018; Kim et al, 2020; Wang et al, 2020). The confluence angles of the vertebrobasilar junction (VBJ) vary from 10◦ to 160◦ (Ravensbergen et al, 1996, 1998). Previous research showed that patients with deep pontine lacunar infarction had significantly larger VBJ angles than healthy individuals (Jeong et al, 2015). The larger VBJ angles were revealed in robust relevance to the hemodynamic alteration, thereby leading to the proneness to vertebrobasilar atherosclerosis in the numerical and experimental models (Ravensbergen et al, 1996, 1998; Zhang et al, 2016). Little clinical evidence from stroke patients could be provided to ascertain the relationship between the varying VBJ angle degrees and the progression of vertebrobasilar atherosclerosis

Results

Discussion

Conclusion