Effect of Hemodynamics on Stroke Risk in Symptomatic Atherosclerotic Vertebrobasilar Occlusive Disease

Abstract

for the Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS) Study Group IMPORTANCE Atherosclerotic vertebrobasilar (VB) occlusive disease is a significant etiology of posterior circulation stroke, with regional hypoperfusion as an important potential contributor to stroke risk.OBJECTIVE To test the hypothesis that, among patients with symptomatic VB stenosis or occlusion, those with distal blood flow compromise as measured by large-vessel quantitative magnetic resonance angiography (QMRA) are at higher risk of subsequent posterior circulation stroke. DESIGN, SETTING, AND PARTICIPANTSA prospective, blinded, longitudinal cohort study was conducted at 5 academic hospital-based centers in the United States and Canada; 82 patients from inpatient and outpatient settings were enrolled. Participants with recent VB transient ischemic attack or stroke and 50% or more atherosclerotic stenosis or occlusion in vertebral and/or basilar arteries underwent large-vessel flow measurement in the VB territory using QMRA. Physicians performing follow-up assessments were blinded to QMRA flow status. Follow-up included monthly telephone calls for 12 months and biannual clinical visits (for a minimum of 12 months, and up to 24 months or the final visit). Enrollment took place from

Four-dimensional MRI flow examinations in cerebral and extracerebral vessels – ready for clinical routine?

“…peak velocity, volume flow rates) have been postulated to be valuable in stratifying the risk of atherosclerotic plaque rupture and/or perfusion dependent recurrent stroke. Doppler ultrasound (58–61) and 2D phase-contrast MRA (62–64) are two established techniques that have been applied to quantitatively evaluate atherosclerosis-induced regional hemodynamic alterations, recently with clinical trial evidence that low flow status predisposes to ischemic stroke in vertebral-basilar atherosclerotic disease (65). Other hemodynamic parameters that may provide insight into atherosclerotic disease progression in carotid stenosis include WSS and blood flow velocity in the common carotid artery and carotid bifurcation (66).…”

One-Year Risk of Recurrent Stroke and Death Associated with Vertebrobasilar Artery Stenosis and Occlusion in a Cohort of 10,515 Patients

“…Clinical criteria, such as both Face Arm Speech Test and ABCD2 scores, are less effective in the diagnosis and identification of high-risk cases for posterior circulation stroke [35]. Low-flow distal to stenosis determined using large-vessel quantitative magnetic resonance angiography has been identified as a predictor for subsequent stroke in patients with symptomatic VBA occlusive disease [36]. The 12-and 24-month stroke-free survival rates of 78 and 70%, respectively, in the low-flow group were lower than 96 and 87%, respectively, in the normal-flow group.…”

Higher Stroke Risk with Lower Blood Pressure in Hemodynamic Vertebrobasilar Disease: Analysis from the VERiTAS Study

“…The study protocol was approved by the institutional review boards at each participating site, and written informed consent was provided by each study participant. Details of the study design, characteristics of the cohort, and primary results indicating distal flow status as a predictor of subsequent stroke risk have been previously published(6-8). …”