Abstract 14021: Angiographic and Hemodynamic Features of Symptomatic Vertebrobasilar Disease: Baseline Data from the VERiTAS Study
Introduction: Atherosclerotic vertebrobasilar disease (VBD) is a significant etiology of posterior circulation stroke. In addition to thromboembolism, regional hypoperfusion is considered an important potential contributor to stroke risk. To examine the role of hemodynamic compromise in VBD, a prospective observational multi-center study, Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS), has recently been conducted. Here we report baseline features and vessel flow measurements from the study cohort.
Methods: Baseline demographic and clinical data was collected in patients with recent vertebrobasilar TIA or stroke and ≥50% atherosclerotic stenosis or occlusion in vertebral and/or basilar arteries. Large vessel flow in the vertebrobasilar territory was assessed using quantitative MRA (QMRA).
Results: The cohort (n=75, 56% male) had a mean age of 65.5 (range 40 to 90) years; two thirds presented with ischemic stroke. Hypertension (93%) and hyperlipidemia (79%) were the most prevalent vascular risk factors. Vertebral and basilar artery flows correlated negatively with degree of stenosis in the affected vessel, and positively to the minimal diameter at the site of stenosis (p<0.01). A threshold effect was evident, with affected vessel flows dropping significantly in patients with ≥70% stenosis or occlusion (p<0.05). Tandem disease involving the basilar and either or both the vertebrals had the greatest impact on immediate downstream flow in the basilar artery (38 ml/min vs. 74 ml/min, p<0.01). Assessment of distal flow status, incorporating collateral flow, however correlated neither with multifocality of disease nor severity of the maximal stenosis.
Conclusions: Flow in stenotic posterior circulation vessels correlate with residual diameter and stenosis and drop significantly in the setting of tandem disease. However, distal flow status, incorporating collateral capacity, is not well predicted by the severity or location of the disease. Final clinical outcome results from the ongoing VERiTAS study will further clarify the relevance of anatomic stenosis and hemodynamic assessment to predicting stroke risk in patients with vertebrobasilar disease.
Author Disclosures: S. Amin-Hanjani: Other Research Support; Modest; GE Healthcare, VasSol, Inc. Research Grant; Significant; NIH/NINDS. X. Du: None. L. Rose-Finnell: None. D. Pandey: Research Grant; Modest; NIH/NINDS. D. Richardson: None. H. Xie: None. K.R. Thulborn: Ownership Interest; Significant; Thulborn Assoc., Inc. (owner). M.S. Elkind: None. G.J. Zipfel: Research Grant; Modest; American Heart Association Hope Center for Neurological Disorders Pfizer Barnes Jewish Hospital Foundation.. Research Grant; Significant; NIH. D.S. Liebeskind: None. F.L. Silver: Other Research Support; Significant; Boehringer Ingelheim Canada. Speakers Bureau; Modest; Servier. Speakers Bureau; Significant; Boehringer Ingelheim Canada. J. Kramer: None. S.E. Kasner: None. L.R. Caplan: None. C.P. Derdeyn: Research Grant; Significant; NIKH/NINDS; MicroVention, Inc.. Ownership Interest; Modest; Pulse Therapeutics; nFocus Inc.. Consultant/Advisory Board; Modest; Pulse Therapeutics. Consultant/Advisory Board; Significant; W.L. Gore and Associates. P.B. Gorelick: Research Grant; Significant; Lundbeck Inc. F.T. Charbel: Ownership Interest; Significant; VasSol Inc..
- © 2014 by American Heart Association, Inc.