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      The association between vertebral artery hypoplasia and fetal‐type variants of the posterior cerebral artery with imaging findings among patients with posterior circulation stroke: A single‐center cross‐sectional study

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          Abstract

          Background and Aim

          The present study investigated the correlation between vertebral artery hypoplasia and fetal‐type variations of posterior cerebral arteries with stroke patterns and imaging findings in individuals with posterior circulation ischemic stroke.

          Methods

          In this cross‐sectional study, patients with symptoms of acute ischemic stroke in the posterior circulation system referred to Ghaem Hospital in Mashhad between 2016 and 2022 were investigated. Demographic data, including age, gender, systemic diseases, history of previous stroke or transient ischemic attacks, and clinical manifestations of patients, were recorded using questionnaires and checklists from patient files. The results of imaging studies, including magnetic resonance imaging and computed tomography angiography, were also recorded. The obtained data were analyzed by SPSS statistical software.

          Results

          Among 974 patients suffering from posterior circulation ischemic stroke, 155 patients with an average age of 60.44 ± 13.95 years were included in the study, out of which 97 patients (62.6%) were male. Unilateral vertebral artery hypoplasia on the right, left, and bilateral hypoplasia was present in 67 (43.2%), 35 (22.6%), and 5 (3.2%) patients, respectively. There were complete unilateral fetal origin on the right in 38 (24.5%), complete unilateral on the left in 12 (7.7%), partial unilateral on the right in 12 (7.7%), partial unilateral on the left in 6 (3.9%), complete bilateral in 14 (9%), and partial bilateral in 8 (5.2%) patients. There was no significant relationship between vertebral artery hypoplasia and PCA fetal‐type variants with different ischemia locations and infarct patterns ( p > 0.05). Also, there was no significant relationship between the age and gender of patients with ischemia location and infarct pattern ( p > 0.05).

          Conclusion

          Despite previous evidence showing a relation between vertebral artery hypoplasia and PCA fetal‐type variants as risk factors for PC stroke, the present study did not establish a significant correlation between these factors and the location of ischemia and infarct patterns.

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          Most cited references32

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          New England Medical Center Posterior Circulation registry.

          Among 407 New England Medical Center Posterior Circulation registry patients, 59% had strokes without transient ischemic attacks (TIAs), 24% had TIAs then strokes, and 16% had only TIAs. Embolism was the commonest stroke mechanism (40% of patients including 24% cardiac origin, 14% intraarterial, 2% cardiac and arterial sources). In 32% large artery occlusive lesions caused hemodynamic brain ischemia. Infarcts most often included the distal posterior circulation territory (rostral brainstem, superior cerebellum and occipital and temporal lobes); the proximal (medulla and posterior inferior cerebellum) and middle (pons and anterior inferior cerebellum) territories were equally involved. Severe occlusive lesions (>50% stenosis) involved more than one large artery in 148 patients; 134 had one artery site involved unilaterally or bilaterally. The commonest occlusive sites were: extracranial vertebral artery (52 patients, 15 bilateral) intracranial vertebral artery (40 patients, 12 bilateral), basilar artery (46 patients). Intraarterial embolism was the commonest mechanism of brain infarction in patients with vertebral artery occlusive disease. Thirty-day mortality was 3.6%. Embolic mechanism, distal territory location, and basilar artery occlusive disease carried the poorest prognosis. The best outcome was in patients who had multiple arterial occlusive sites; they had position-sensitive TIAs during months to years.
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            Blood flow distribution in cerebral arteries.

            High-resolution phase-contrast magnetic resonance imaging can now assess flow in proximal and distal cerebral arteries. The aim of this study was to describe how total cerebral blood flow (tCBF) is distributed into the vascular tree with regard to age, sex and anatomic variations. Forty-nine healthy young (mean 25 years) and 45 elderly (mean 71 years) individuals were included. Blood flow rate (BFR) in 21 intra- and extracerebral arteries was measured. Total cerebral blood flow was defined as BFR in the internal carotid plus vertebral arteries and mean cerebral perfusion as tCBF/brain volume. Carotid/vertebral distribution was 72%/28% and was not related to age, sex, or brain volume. Total cerebral blood flow (717 ± 123 mL/min) was distributed to each side as follows: middle cerebral artery (MCA), 21%; distal MCA, 6%; anterior cerebral artery (ACA), 12%, distal ACA, 4%; ophthalmic artery, 2%; posterior cerebral artery (PCA), 8%; and 20% to basilar artery. Deviating distributions were observed in subjects with 'fetal' PCA. Blood flow rate in cerebral arteries decreased with increasing age (P<0.05) but not in extracerebral arteries. Mean cerebral perfusion was higher in women (women: 61 ± 8; men: 55 ± 6 mL/min/100 mL, P<0.001). The study describes a new method to outline the flow profile of the cerebral vascular tree, including reference values, and should be used for grading the collateral flow system.
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              Posterior circulation ischaemic stroke.

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                Author and article information

                Contributors
                arabmari87@gmail.com
                Journal
                Health Sci Rep
                Health Sci Rep
                10.1002/(ISSN)2398-8835
                HSR2
                Health Science Reports
                John Wiley and Sons Inc. (Hoboken )
                2398-8835
                22 February 2024
                February 2024
                : 7
                : 2 ( doiID: 10.1002/hsr2.v7.2 )
                : e1918
                Affiliations
                [ 1 ] Department of Radiology, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
                [ 2 ] Community Medicine Department, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
                [ 3 ] Department of Radiology, School of Medicine Birjand University of Medical Sciences Birjand Iran
                [ 4 ] Department of Radiology, School of Medicine Mashhad University of Medical Sciences Mashhad Iran
                Author notes
                [*] [* ] Correspondence Marziye Arab, Department of Radiology, School of Medicine, Mashhad University of Medical Sciences, Ahmadabad St, Mashhad 9138813944, Iran.

                Email: arabmari87@ 123456gmail.com

                Author information
                http://orcid.org/0000-0001-9395-4134
                Article
                HSR21918
                10.1002/hsr2.1918
                10883096
                38390352
                a0aab043-e319-4655-953d-6c49014c6eff
                © 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 January 2024
                : 16 October 2023
                : 02 February 2024
                Page count
                Figures: 2, Tables: 7, Pages: 10, Words: 4975
                Categories
                Original Research
                Original Research
                Custom metadata
                2.0
                February 2024
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.8 mode:remove_FC converted:22.02.2024

                fetal origin,posterior circulation,stroke,vertebral artery hypoplasia

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