Infarct Patterns in Patients with Atherosclerotic Vertebrobasilar Disease in Relation to Hemodynamics

Joanna D. Schaafsma, Frank L. Silver, Scott E. Kasner, Louis R. Caplan, Linda Rose-Finnell, Fady T. Charbel, Dilip K. Pandey, Sepideh Amin-Hanjani

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Introduction: Distal territory blood flow is independently associated with subsequent strokes in symptomatic vertebrobasilar atherosclerotic disease. We aimed to assess infarct patterns in relation to hemodynamic status in the prospective Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS) study. Methods: Distal territory blood flow was measured using quantitative magnetic resonance angiography (MRA) in 72 patients with symptomatic atherosclerotic vertebrobasilar disease, and then dichotomized into normal (n = 54) and low (n = 18) flow. Patients were followed longitudinally on standard medical management. Two observers blinded to flow status independently reviewed the imaging performed at the time of subsequent strokes, in order to adjudicate the likely mechanism based on infarct patterns. The frequency of stroke mechanisms was qualitatively compared based on flow status. Results: During a median follow-up period of 23 months, 10/72 patients had a subsequent stroke; 5 of these had low distal flow. Infarct patterns were adjudicated to be consistent with hemodynamic (n = 2), embolic (n = 4), and junctional plaque/perforator (n = 4) infarcts. Hemodynamic infarcts were seen in 40% (2/5) low-flow patients, in comparison to 0% (0/5) normal-flow patients. Conclusion: In contrast to normal-flow patients, those with low distal flow seem to be uniquely susceptible to hemodynamic infarctions, although other patterns of infarction can also be seen in these hemodynamically impaired patients.

Original languageEnglish (US)
Pages (from-to)123-128
Number of pages6
JournalCerebrovascular Diseases Extra
Volume9
Issue number3
DOIs
StatePublished - 2019

Funding

National Institute of Neurological Disorders and Stroke (R01-NS-059745); Dr. Ralph and Marian Falk Research Trust Foundation; other research support (no direct funds) was provided by VasSol, Inc.

Keywords

  • Magnetic resonance angiography
  • Regional blood flow
  • Stroke
  • Vertebrobasilar ischemia

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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