Background Atherosclerotic plaques are often present in regions of arteries with complicated flow patterns. Vascular morphology plays important role in hemodynamics. In this study, we investigated the relationship between the geometry of the vertebrobasilar artery system and presence of basilar artery (BA) plaque. Methods We enrolled 290 patients with posterior circulation ischemic stroke. We distinguished four configurations of the vertebrobasilar artery: Walking, Tuning Fork, Lambda, and No Confluence. Patients were divided into multi-bending (≥ 3 bends) and oligo-bending (< 3 bends) VA groups. The diameter of the vertebral artery (VA) and the number of bends in the intracranial VA segment were assessed using three-dimensional time-of-flight magnetic resonance angiography. High-resolution magnetic resonance imaging was used to evaluate BA plaques. Logistic regression models were used to determine the relationship between the geometry type and BA plaque prevalence. Results After adjusting for sex, age, body mass index ≥ 28, hypertension, and diabetes mellitus, the Walking, Lambda, and No Confluence geometries were associated with the presence of BA plaque (all p < 0.05). Patients with multi-bending VAs in both the Walking (20/28, 71.43% vs. 6/21, 28.57%, p = 0.003) and Lambda group (19/47, 40.43% vs. 21/97, 21.65%, p = 0.018) had more plaques compared to patients with oligo-bending VAs in these groups. In the Lambda group, the difference in diameter of bilateral VAs was larger in patients with BA plaques than that in patients without BA plaques (1.4 mm [IQR: 0.9–1.6 mm] vs. 0.9 mm [IQR: 0.6–1.3 mm], p < 0.001). Conclusions The Walking, Lambda, and No Confluence geometry, ≥ 3 bends in the VAs, and a large diameter difference between bilateral VAs are associated with the presence of BA plaque.

Background: Vascular geometry may play an important role in the development of atherosclerosis. This study aimed to investigate the relationships between the geometrical characteristics of basilar artery (BA) and the presence, burden, and distribution of BA plaques using magnetic resonance vessel wall imaging.Methods: Patients with cerebrovascular symptoms in the posterior circulation were recruited and underwent magnetic resonance imaging. The BA's geometrical characteristics, including actual length, straightened length, tortuosity, lateral basilar artery-vertebral artery (VA) angle, lateral mid-BA angle, and BA convexity, were measured. The presence of plaques, stenosis, and plaque burden, including mean and maximal wall thickness, were evaluated. The BA's cross-sectional vessel wall was divided into 4 quadrants: dorsal, ventral, right, and left quadrant. The distribution of BA plaques was analyzed.Results: Of 344 recruited patients (mean age: 68.1±11.1 years; 200 males), 100 (29.1%) had BA plaques.Patients with BA plaques had higher tortuosity of the BA (13.6±9.0 vs. 9.7±7.7, P<0.001) compared to those without BA plaques. Multivariate regression analysis showed that tortuosity of the BA was associated with the presence of BA plaques (OR, 1.641; 95% CI, 1.232 to 2.186; P=0.001) and mean wall thickness (β, 0.045; 95% CI, 0.008 to 0.081; P=0.017). The plaque distribution in the left wall and right wall of BA was more frequent in patients with right (P=0.006) and left (P<0.001) convex BA, respectively.Conclusions: The BA's geometrical characteristics, particularly tortuosity and convexity, are independently associated with the presence, burden, and distribution of plaques in the BA.

BackgroundBasilar artery (BA) atherosclerosis is a common cause of posterior-circulation ischemic stroke. In this study, we investigate the relationship between BA plaque distribution and pontine infarction (PI), further, explore the influence of vertebrobasilar artery (VBA) geometries on BA plaque distribution.Materials and methods303 patients were performed with MRI in this study, patients were divided into three groups: no cerebral infarction (NCI), anterior circulation cerebral infarction (ACCI), and posterior circulation cerebral infarction (PCCI), the VBA geometry was classified into four configurations: Walking, Tuning Fork, Lambda, and No Confluence. The AP-Mid-BA, Lateral-Mid-BA, and VA-BA angles were measured on three-dimensional time-of-flight magnetic resonance angiography. Patients underwent high-resolution magnetic resonance imaging to evaluate the BA plaque distribution (either anterior, posterior, or lateral wall). Acute and subacute cerebral infarction [including pontine infarction (PI)] were identified by T2 weighted imaging-fluid-attenuated inversion recovery and diffusion-weighted imaging.ResultsThe presence of BA plaque (P &lt; 0.001) were associated with PCCI. Eighty-six patients all with BA plaque were further analyzed, compared with patients without pontine infarction, patients with pontine infarction were more likely to have plaque distributed at the posterior wall (P = 0.009) and have larger VA-BA anger (38.72° ± 26.01° vs. 26.59° ± 17.33°, P = 0.035). BA plaques in patients with pontine infarction were more frequently located at the posterior wall (50.00%) than at the anterior (10.00%) and lateral (37.50%) walls (P = 0.028). In Walking, Lambda and No Confluence geometry, BA plaques were prone to located at the lateral wall than at the anterior and posterior walls (all P ≤ 0.05). In the Tuning Fork group, BA plaques were evenly distributed.ConclusionBA plaque was related to PCCI, BA plaque distribution was associated with PI, and VBA configuration strongly influences BA plaque distribution.

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Background: Basilar artery (BA) atherosclerosis is a common cause of posterior-circulation ischemic stroke. In this study, we investigate the relationship between BA plaque distribution, pontine infarction (PI) and vertebrobasilar artery (VBA) geometries. Methods: 86 patients with BA plaque were enrolled in this study, the VBA geometry was classified into four configurations: walking, tuning fork, lambda, and no confluence. The AP-Mid-BA, Lateral-Mid-BA, and VA-BA angles were measured on three-dimensional time-of-flight magnetic resonance angiography. Patients underwent high-resolution magnetic resonance imaging to evaluate the BA plaque distribution (either anterior, posterior, or lateral wall). Acute and subacute PIs were identified by T2 weighted imaging-fluid-attenuated inversion recovery and diffusion-weighted imaging.Results: BA plaques in patients with PI were more frequently located at the posterior wall (50.00%) than at the anterior (10.00%) and lateral (37.50%) walls (P =0.028).Compared with patients without pontine infarction, patients with pontine infarction were more likely to have plaque distributed at the posterior wall (P = 0.009). In the tuning fork group, BA plaques were evenly distributed. BA plaques were more frequently located at the lateral wall than at the anterior and posterior walls in patients with walking, lambda, and no confluence geometry (all P ≤ 0.05). The AP-Mid-BA angle in patients with a tuning fork configuration (14.950±11.660) was lower than that in patients with other vascular geometries (P=0.001); there was no significant difference in the VA-BA angle and lateral-mid-BA angle among the four VBA geometries (P >0.05).Conclusion: VBA configuration strongly influences BA plaque distribution and BA plaque distribution was associated with PI.