Basilar Artery Angulation in Association with Aging and Pontine Lacunar Infarction: A Multicenter Observational Study

Abstract

Aim: Deep pontine lacunar infarction (DPLI) not involving the basal pial surface of the medial part of the pons, is known to be a small vessel disease in the territory of the basilar artery (BA). In the present study, we examined whether morphological features of the BA differ in individuals with an advanced age and may be associated with DPLI. Methods: This study included 338 healthy subjects and 78 patients with DPLI treated at the stroke centers of three university hospitals in Korea. Time-Of-Flight magnetic resonance angiographic images were transported to a central lab and analyzed blind to obtain the clinical data. For the quantitative analysis, the BA was projected two-dimensionally in the anteroposterior and lateral views and perceived as triangles of the vertebrobasilar junction, angulation point and BA division. The angles and triangular areas were summated into angulation indexes and used to quantify the degree of BA tortuosity. Results: The BA showed a more acute angle at the angulation point in the elderly patients than in the healthy subjects. Compared to the healthy subjects, the DPLI patients exhibited significantly larger angles at the vertebrobasilar junction, in addition to the acute angles noted at the angulation point. A unit increase in the BA angle indexes at the vertebrobasilar junction and angulation points for DPLI was found to have an odds ratio of 1.15 (95% confidence interval, 1.05-1.26) and 0.95 (95% CI, 0.91-0.99), respectively, even after adjusting for potential confounders. Conclusions: The angulation point of the BA becomes more acute in elderly individuals. In this study, the vertebrobasilar junction showed a larger angle in the patients with DPLI than in the healthy controls. J Atheroscler Thromb, 2015; 22: 509-517.

Increased tortuosity of basilar artery might be associated with higher risk of aneurysm development

“…A similar correlation was also found in studies concerning coronary arteries [ 35 ]. An explanation for such a finding could be the fact that both artery diameters [ 35 ] and BA bifurcation angle [ 36 ] increase with age, which is also related to tortuosity. Larger artery diameters could also indicate its walls weakening, as well as larger blood flow, which also promotes tortuosity [ 4 , 31 ].…”

Asymptomatic Basilar Artery Plaque Distribution and Vascular Geometry

“…The BA curvature observed from the AP view is affected by the unequal blood flow from the VAs 4) . The congenital asymmetric flow of VA progressively curves and elongates the BA in an asymmetric manner and results in a convexity of BA to the opposite side of dominant VA 17) . In addition, pontine infarctions were predominantly located at the inner side of BA curvature, which was explained by the traction of pontine perforators or the higher thrombogenicity in the inner curvature 4) .…”

Basilar Artery Plaque and Pontine Infarction Location and Vascular Geometry

“…Vascular geometry of the parental artery affects the hemodynamics inside the vasculature and likely determines preclinical atherosclerosis location [ 6 ]. Furthermore, the angulation of the parental artery might be associated with infarction presence and location [ 7 , 8 ]. In the vertebrobasilar system, turbulence occurs at the vertebrobasilar junction, where the two VA flows conjoin, and at the mid-BA when the flow bends because of the mid-BA angle [ 9 , 10 ].…”