Optimized hemodynamic assessment to predict stroke risk in vertebrobasilar disease: Analysis from the veritas study

Alfred P. See, Dilip K. Pandey, Xinjian Du, Linda Rose-Finnell, Fady T. Charbel, Colin P. Derdeyn, Sepideh Amin-Hanjani*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

BACKGROUND: Atherosclerotic vertebrobasilar disease is a significant etiology of posterior circulation stroke. The prospective observational VERiTAS (Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke) study demonstrated that distal hemodynamic status is a robust predictor of subsequent vertebrobasilar stroke risk. We sought to compare predictive models using thresholds for posterior circulation vessel flows standardized to age and vascular anatomy to optimize risk prediction. METHODS AND RESULTS: VERiTAS enrolled patients with recent vertebrobasilar transient ischemic attack or stroke and ≥50% atherosclerotic stenosis/occlusion in vertebral and/or basilar arteries. Quantitative magnetic resonance angiography measured large-vessel vertebrobasilar territory flow, and patients were designated as low or normal flow based on a prespecified empiric algorithm considering distal territory regional flow and collateral capacity. For the present study, post hoc analysis was performed to generate additional predictive models using age-specific normalized flow measurements. Sensitivity, specificity, and time-to-event analyses were compared between the algorithms. The original prespecified algorithm had 50% sensitivity and 79% specificity for future stroke risk prediction; using a predictive model based on age-normalized flows in the basilar and posterior cerebral arteries, standardized to vascular anatomy, optimized flow status thresholds were identified. The optimized algorithm maintained sensitivity and increased specificity to 84%, while demonstrating a larger and more significant hazard ratio for stroke on time-to-event analysis. CONCLUSIONS: These results indicate that flow remains a strong predictor of stroke across different predictive models, and suggest that prediction of future stroke risk can be optimized by use of vascular anatomy and age-specific normalized flows.

Original languageEnglish (US)
Article numbere016406
JournalJournal of the American Heart Association
Volume9
Issue number12
DOIs
StatePublished - Jun 16 2020

Funding

The study was funded by grant R01 NS 059745 from the National Institutes of Health/National Institute of Neurological Disorders and Stroke. Additional funding and support was provided by the Dr Ralph and Marian Falk Research Trust Foundation. Material research suppor t was provided by VasSol Inc (suppl ying NOVA technology and technical support). The study was funded by grant R01 NS 059745 from the National Institutes of Health/National Institute of Neurological Disorders and Stroke. Additional funding and support was provided by the Dr Ralph and Marian Falk Research Trust Foundation. Material research support was provided by VasSol Inc (supplying NOVA technology and technical support).

Keywords

  • Blood flow
  • Magnetic resonance angiography
  • Magnetic resonance imaging
  • Quantitative magnetic resonance angiography
  • Stroke vertebrobasilar disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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