Geometric Analysis and Blood Flow Simulation of Basilar Artery

Lee, Sang Hyuk; Hur, Nahmkeon; Jeong, Seul-Ki

doi:10.5551/jat.10694

Cited by 19 publications

(15 citation statements)

References 24 publications

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“…It has been reported that vertebrobasilar artery tortuosity is associated with connective tissue disorders [18], reduced elasticity and degeneration of blood vessels, and vascular wall shear stress [3,19]. Vascular risk factors such as hypertension, diabetes and lipid metabolism disorders can promote atherosclerosis, aging, and degeneration of blood vessels, thereby aggravating vertebrobasilar artery tortuosity [20].…”

Section: Discussionmentioning

confidence: 99%

Two case reports of bilateral vertebral artery tortuosity and spiral twisting in vascular vertigo

Zhang

2014

BMC Neurol

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Background: Tortuous blood vessels are commonly seen in the cerebral arteries. The association between vertebrobasilar artery tortuosity and vascular vertigo remains obscure. Case presentation: We describe two patients with vascular vertigo who had bilateral curving and spiral looping in multiple segments of the vertebral arteries and also exhibited basilar artery tortuosity. Both patients had cerebrovascular risk factors and exhibited clinical features of vertigo with high severity, slow recovery, and recurrent tendencies. Contrast enhanced magnetic resonance angiography of the neck showed bilateral tortuosity in the V2 segments and spiral twisting in the V4 segments of the vertebral arteries, and basilar artery curving. No obvious sign of atherosclerotic stenosis was found in the vertebrobasilar arteries and no abnormalities were observed in the internal carotid arteries. Transcranial Doppler ultrasound showed decreased blood flow in tortuous vertebrobasilar arteries. Brainstem auditory evoked potentials showed that the interpeak latencies (IPL) of waves III-IV were prolonged, with a ratio of IPL III-V/IPL I-III > 1. Conclusions: Vertebrobasilar tortuosity in combination with cerebrovascular risk factors may lead to vascular vertigo in these patients.

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Section: Discussionmentioning

confidence: 99%

Two case reports of bilateral vertebral artery tortuosity and spiral twisting in vascular vertigo

Zhang

2014

BMC Neurol

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“…The morphological features of the vertebrobasilar artery have been previously reported to have hemodynamic effects on brainstem infarction [16][17][18] . The hemodynamics of the BA are more effectively interpreted based on the two components of angulation, as these features determine the flow dynamics and rate of atherosclerotic progression 2) . In the present study, most of the subjects showed anterior angulation of the BA on the lateral view ( Table 1), such that the regions experiencing low wall shear stress along the lesser curvariation in the size of the vertebral arteries may affect the extent of lateral angulation, while the differences in the confluent angles from the vertebral arteries to the BA may influence the amount of anterior angulation.…”

Section: Discussionmentioning

confidence: 99%

“…In order to identify and analyze hemodynamic information for the BA, we simplified the BA as triangles with two references (the vertebrobasilar junction and the division of the BA) and angulation points. Axial source images of the vertebrobasilar artery were obtained via TOF MR angiography and used to reconstruct multiplanar sections in the same screen, including the XZ (coronal) and YZ (sagittal) planes, with our own in-house code, as previously described 2) . Using the multiplanar sections, the two references and the most angulated points were selected and designated as three-dimensional (3D) Cartesian coordinates.…”

Section: Study Populationmentioning

confidence: 99%

“…A unique feature of the BA is that it displays angulation in its course due to its anatomic relationships with surrounding structures, with two components of BA angulation to be analyzed, as we reported previously 2) . National University Hospital, Jeonju City; Chonnam National University Hospital, Gwangju City; and Wonkwang University Hospital, Iksan City) during the same time period.…”

Section: Introductionmentioning

confidence: 99%

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

Jeong

Nam

Kim

et al. 2015

J Atheroscler Thromb

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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.

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“…The low shear stress may result in altered physiological responses that include a decrease in endothelial nitric oxide synthase mRNA and protein expression,22 increased release of proinflammatory mediators such as macrophage chemoattractant-1,23 increased uptake of oxidized LDL,24 altered redox state of the vasculature, and altered smooth-muscle-cell gene expression 25. Regions of low arterial shear stress are considered to be vulnerable to future atherosclerotic growth26 and thrombosis evolution 2,3. However, the exact mechanisms underlying how low arterial shear stress affects neurovascular units and cerebrovascular networks need further evaluation 27…”

Section: Discussionmentioning

confidence: 99%

Association between Ischemic Stroke and Vascular Shear Stress in the Carotid Artery

2014

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Background and PurposeVascular shear stress is essential for maintaining the morphology and function of endothelial cells. We hypothesized that shear stress in the internal carotid artery (ICA) may differ between patients with ischemic stroke and healthy control subjects.MethodsICA shear stress was calculated in 143 controls and 122 patients with ischemic stroke who had a normal ICA or an ICA with <50% stenosis. The stroke group included patients who presented with a first-ever or recurrent ischemic stroke but excluded cardioembolic stroke and uncertain etiologies. Of the 122 patients, 107 (87.7%) and 15 (12.3%) patients were categorized as first-ever and recurrent stroke, respectively.ResultsCarotid diameters were significantly larger, and both peak-systolic and end-diastolic velocities were significantly lower in patients with ischemic stroke than in controls (all p values <0.05). Mean values of peak-systolic and end-diastolic shear stress in both ICAs were significantly lower in patients with ischemic stroke in models that adjusted for age, sex, and vascular risk factors (p for trend <0.05). The ICA shear stress was lowest in patients with recurrent stroke or the subtype of small-vessel occlusion. Higher peak-systolic and end-diastolic shear stresses in both ICAs were independently and negatively associated with ischemic stroke after adjusting for potential confounders (all p values <0.05).ConclusionsICA shear stresses were significantly lower in patients with ischemic stroke than in control subjects. Future studies should attempt to define the causal relationship between carotid arterial shear stress and ischemic stroke.

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Geometric Analysis and Blood Flow Simulation of Basilar Artery

Cited by 19 publications

References 24 publications

Two case reports of bilateral vertebral artery tortuosity and spiral twisting in vascular vertigo

Two case reports of bilateral vertebral artery tortuosity and spiral twisting in vascular vertigo

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

Association between Ischemic Stroke and Vascular Shear Stress in the Carotid Artery

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