BackgroundThe clinical significance of vertebral artery (VA) hypoplasia is under discussion. The aim of this retrospective study is to evaluate a hypothesis of a possible causal link between VA hypoplasia (VAH) and the incidence of posterior circulation stroke (PCS) or TIA depending on the degree of VAH  and vascular risk factors.MethodsA total of 367 symptomatic (PCS or TIA) and 742 asymptomatic subjects, were selected to participate in the study. The extracranial arteries were examined by ultrasound. VAH was defined as VA diameter in entire course <3 mm, although different degrees of VAH were examined. All the symptomatic patients underwent MRI or CT and MRA or CTA. The study assessed all the subjects in terms of their age, gender, co-risk factors (hypertension, hyperlipidemia, diabetes mellitus, peripheral arterial diseases, atrial fibrillation, myocardial infarction), as well as height of 180 healthy volunteers.ResultsVAH, regardless of the degree of severity, was more frequent in patients with non-cardioembolic PCS or TIA rather than in asymptomatic patients. The increasing degree of hypoplasia in patients under 65 years of age was a predictor of PCS/TIA, OR = 1.8, 95 % CI: 1.3-2.5; p < 0.001. In subjects older than 65 years of age, this association failed. Only in patients aged under 50, VAH was significantly more frequent in the TIA group rather than in the PCS group (68.2 % and 50 %, respectively; p = 0.047). The optimal VA diameter cutoff point separating PCS/TIA and asymptomatic group was 2.7 mm. This value may vary in different populations, because VA diameter showed a significant dependence on sex as well as anthropometric parameters (height). With the increasing degree of VAH, the likelihood of the occurrence of the distal VA part stenosis/occlusion was growing (OR = 1.6, 95 % CI: 1.2-2.1; p = 0.002). The distal VA stenosis/occlusion was likely to occur where the VA diameter was <2.2 mm.ConclusionsThe impact of the VAH on PCS/TIA and its pathogenetic mechanism was significantly influenced by age. The cutoff point of VA diameter, affecting the occurrence of PCS in different populations may vary because VA diameter depends on gender and anthropometric parameters (especially height).

BackgroundIt is not clear whether the configuration of the posterior part of the circle of Willis (CW) depends on the proximal part of the vertebrobasilar system. Our aim is to evaluate the posterior part of CW in association with different size of vertebral arteries (VA) in healthy volunteers.Materials and methodsThe present study was based on a sample of 923 healthy volunteers who were examined from 2013 through 2018. The duplex ultrasonographic examination of the extracranial vertebral (VA) and carotid arteries was performed. VA was defined as hypoplastic (VAH) when VA diameter in the entire course was less than 2.5 mm. All the participants underwent magnetic resonance angiography (MRA) examination. All the component vessels of the circle of Willis were assessed in each individual. We classified the posterior communicating artery (PCoA) as presence PCoA, absence/hypoplastic PCoA and fetal-type posterior circle of Willis (FCW) in which the major stem of the posterior cerebral artery (PCA) arises from ipsilateral internal carotid artery (ICA). The comparison of the posterior part of CW was made in subjects with normal VA and VAH of a different degree (communicating with basilar artery (VAH-BA) and not communicating with the basilar artery (VAH-PICA)).ResultsFCW was found in 15.9% of subjects, bilaterally–in 2.3%. FCW was more frequent in individuals with VAH than in those with normal VA (accordingly, 28.8% vs. 13.5%, p<0.001. Moreover FCW was recorded in 50% of the subjects with VA—PICA in comparison with 13.5% of those with normal VA and 22.8% with VAH—BA, p<0.005. On the contrary, absence/hypoplasia of both PCoA was mostly found in the group with normal VA in comparison with VAH-BA and VAH-PICA (accordingly, 50.7%, 38.6% and 12.5%, p<0.01).ConclusionIndividuals with VAH have a different pattern of the posterior part of CW in comparison with those with normal VA. With the increasing degree of VAH, the proportion of FCW increases, while the proportion of absence/hypoplastic of both PCoA decreases.

Reikšminiai žodžiai: asmenybės D tipas, depresiškumo lygmuo, elektrokardiostimuliatorius, gyvenimo kokybė, Aquarel skalė. Darbo tikslas. Išsiaiškinti, ar D tipo asmenybės bruožai bei depresiškumo lygmuo susiję su gyvenimo kokybe pacientų, kuriems implantuotas elektrokardiostimuliatorius (EKS). Tyrimo medžiaga ir metodai. Tirti 100 asmenų, kurie sirgo kardiovaskuline liga, iš jų 50 – su implantuotu EKS (amžiaus vidurkis 67,26 ± 9,73 metų), 50 – kontrolinė grupė be EKS (amžiaus vidurkis 68,08 ± 9,69). Tyrime naudotas specifinis Aquarel klausimynas gyvenimo kokybei ir susijusiems kardiologiniams simptomams įvertinti (M. A. Stofmeel ir kt., 2001), D tipo asmenybės skalė 14 (Type D scale 14, DS14, Denollet, 2005), Beko depresijos skalė (BDI-II, 1961). Rezultatai. Iš visų tiriamųjų D tipo asmenybių su neigiamo emocingumo ir socialinio uždarumo bruožais buvo 41 proc. Grupėje su implantuotu EKS tokio tipo asmenybių buvo reikšmingai daugiau (54 proc.). Depresiškumo lygmuo abiejose grupėse buvo panašus ir reikšmingai nesiskyrė. Gyvenimo kokybės balai buvo reikšmingai mažesni pacientams su implantuotu EKS (64,33 ± 16,95), palyginti su tiriamaisiais be EKS (83,45 ± 14,95), ir dar mažesni D tipo asmenybėms su EKS (58,8 ± 17,93), palyginti su ne D tipo asmenybėmis (70,82 ± 13,38) be EKS. Koreliacinė analizė parodė reikšmingas sąsajas tarp visų tiriamųjų gyvenimo kokybės ir D tipo asmenybės bruožų, amžiaus, depresiškumo lygmens. Gyvenimo kokybė buvo reikšmingai susijusi su neigiamu emocingumu (r = -0,592) ir depresiškumo lygmeniu (r = -0,615) D tipo asmenybėms, o ne D tipo asmenybių gyvenimo kokybė koreliavosi tik su depresiškumo lygmeniu (r = -0,5). Prognostinis tiesinės regresijos modelis parodė, kad reikšmingiausią ir stipriausią poveikį D tipo asmenybių gyvenimo kokybei turėjo depresiškumo lygmuo (β = -0,552). Išvados. Tirtų asmenų depresiškumo lygmuo nesusijęs su elektrokardiostimuliatoriaus implantacija. D tipo asmenybės bruožai – neigiamas emocingumas ir socialinis uždarumas reikšmingai dažnesni pacientams su elektrokardiostimuliatoriumi ir reikšmingai atvirkščiai susiję su jų gyvenimo kokybe. Pacientų su elektrokardiostimuliatoriumi depresiškumo lygmuo ir gyvenimo kokybė tarpusavyje stipriai susiję nepriklausomai nuo asmenybės tipo, o neigiamas emocingumas su gyvenimo kokybe stipriai susiję tik D tipo asmenybėms. Depresiškumo lygmuo ir D tipo asmenybės neigiamas emocingumas yra stipriausi prognostiniai veiksniai, kurie lemia blogesnę gyvenimo kokybę.

Background: Neurological deterioration (ND) after mechanical thrombectomy (MT) of acute ischemic stroke (AIS) in anterior circulation is an important complication associated with a poor outcome. Moreover, evident causes of ND may remain unexplained (UnND). Objective: We sought to evaluate the association of the systolic blood pressure (SBP) parameters before MT, during MT, and during a 24-h period after MT with UnND. Methods: We analyzed 382 MT-treated AIS patients in two stroke centers from 2017 to 2019. The patients with unsuccessful recanalization and/or with symptomatic intracerebral hemorrhage after MT were excluded. Multivariate logistic regression analysis was used to identify the SBP parameters that predict UnND. Results: There were 5.9% patients with UnND within 24 h after MT among patients with successful recanalization what comprises 4.9% of all patients who had undergone MT. SBP > 180 mmHg on admission (odds ratio (OR): 4, 95% confidence interval (CI): 1.6–10, p = 0.004) and a drop of SBP below100 mmHg during MT (OR: 4.7, 95% CI: 1.3–17, p = 0.019) were associated with UnND occurrence within 7 days without a significant association with UnND within 24 h. UnND within 7 days was predicted by the episodes of SBP exceeding the level of SBP observed before the groin puncture and occurring over the first 2 h following recanalization (OR: 5, 95% CI: 1.3–19, p = 0.021), an increase of SBP of more than 20% within 2–24 h after MT (OR: 3.4, 95% CI: 1.1–10, p = 0.035), and a drop of SBP below 100 mmHg after MT (OR: 3.2, 95% CI: 1.1–9, p = 0.039). Conclusion: The association between the SBP parameters and UnND depends on the treatment period and the time of UnND occurrence. The J/U resembling relationship between SBP and UnEND was established during a 24-h period after MT.

Raktažodžiai: dirbtiniai kraujagyslių modeliai, intrakranijinės aneurizmos, metodologija. Santrauka. Tikslas. Sukurti ir aprašyti kraujagyslių su intrakranijine aneurizma in vitro modelį