Background
Methods
Patient inclusion and clinical assessments
MR imaging study
Other clinical considerations
Statistical analysis
Results
Patient inclusion
Total (n = 137) | Vertebral artery origin stenosis | P-value | ||
---|---|---|---|---|
Asymptomatic (n = 64) | Symptomatic (n = 73) | |||
Age, years (mean ± SD) | 70.4 ± 10.3 | 71.5 ± 10.8 | 69.5 ± 9.9 | 0.247 |
Male (n,%) | 73 (53.3) | 40 (62.5) | 33 (45.2) | 0.043 |
Hypertension (n,%) | 96 (70.1) | 46 (71.9) | 50 (68.5) | 0.666 |
Diabetes (n,%) | 66 (48.2) | 30 (46.9) | 36 (49.3) | 0.776 |
Hyperlipidemia (n,%) | 56 (40.9) | 28 (43.8) | 28 (38.4) | 0.522 |
Atrial fibrillation (n,%) | 6. (4.4) | 4 (6.3) | 2 (2.7) | 0.316 |
Smoking (n,%) | 61 (44.5) | 29 (45.3) | 32 (43.8) | 0.862 |
Previous stroke history (n,%) | 34 (24.8) | 20 (31.3) | 14 (19.2) | 0.103 |
Coronary arterial disease | 27 (19.7) | 12 (18.8) | 15 (20.5) | 0.792 |
Peripheral arterial disease | 5 (3.6) | 2 (3.1) | 3 (4.1) | 0.759 |
ESRS (mean ± SD) | 3.2 ± 1.5 | 3.3 ± 1.5 | 3.1 ± 1.4 | 0.339 |
Concurrent vertebrobasilar stenosis* | 42 (30.7) | 14 (21.9) | 28 (38.4) | 0.037 |
Concurrent carotid stenosis†
| 28 (20.4) | 16 (25.0) | 12 (16.4) | 0.215 |
Stroke subtype | 0.304 | |||
Small artery occlusion | 39 (28.5) | 21 (32.8) | 18 (24.7) | |
Large artery atherosclerosis | 48 (35.0) | 24 (37.5) | 24 (32.9) | |
Cardioembolism | 11 (8.0) | 6 (9.4) | 5 (6.8) | |
Two or more causes | 16 (11.7) | 4 (6.3) | 12 (16.4) | |
Negative evaluation | 23 (16.8) | 9 (14.1) | 14 (19.2) |
CE-MRA vs. conventional angiography
Performance of the optimal medical treatment
Baseline | 3-month follow-up | 12-month follow-up | ||
---|---|---|---|---|
Asymptomatic VAO stenosis (n = 64) | Systolic BP (mmHg) | 151.0 ± 29.3 (n = 64) | 124.5 ± 15.4 (n = 51)* | 123.4 ± 13.8 (n = 42)* |
Diastolic BP (mmHg) | 84.6 ± 16.0 (n = 64) | 71.0 ± 10.1 (n = 51)* | 71.5 ± 8.8 (n = 42)* | |
Total cholesterol (mg/dl) | 171.8 ± 36.7 (n = 63) | 141.0 ± 34.7 (n = 49)* | ||
LDL cholesterol (mg/dl) | 107.9 ± 29.7 (n = 59) | 80.7 ± 31.3 (n = 27)* | ||
HDL cholesterol (mg/dl) | 43.3 ± 10.5 (n = 63) | 44.8 ± 11.7 (n = 48) | ||
HbA1c (%)§
| 8.0 ± 2.2 (n = 30) | 7.0 ± 1.2 (n = 23)‡
| ||
Number of evaluated patients | 55 | 45 | ||
Antihypertensive drug (n,%) | 42 (76.4) | 37 (82.2) | ||
Antiplatelet agent or oral anticoagulant (n,%) | 53 (96.4) | 41 (91.1) | ||
Statin (n,%) | 36 (65.5) | 33 (73.3) | ||
Symptomatic VAO stenosis (n = 73) | Systolic BP (mmHg) | 152.6 ± 22.6 (n = 73) | 123.3 ± 16.0 (n = 57)* | 125.6 ± 14.8 (n = 49)* |
Diastolic BP (mmHg) | 82.4 ± 15.3 (n = 73) | 69.9 ± 9.7 (n = 57)* | 72.8 ± 10.6 (n = 49)* | |
Total cholesterol (mg/dl) | 185.8 ± 37.3 (n = 73) | 148.0 ± 31.7 (n = 53)* | ||
LDL cholesterol (mg/dl) | 112.0 ± 31.2 (n = 70) | 81.0 ± 27.5 (n = 30)* | ||
HDL cholesterol (mg/dl) | 44.9 ± 10.6 (n = 73) | 47.1 ± 17.6 (n = 52) | ||
HbA1c (%)§
| 8.3 ± 1.7 (n = 35) | 7.3 ± 0.9 (n = 22)†
| ||
Number of evaluated patients | 59 | 51 | ||
Antihypertensive drug (n,%) | 39 (66.1) | 37 (72.5) | ||
Antiplatelet agent or oral anticoagulant (n,%) | 58 (98.3) | 49 (96.1) | ||
Statin (n,%) | 45 (76.3) | 39 (76.5) |
Stroke recurrence and vascular outcome
Incidence, number of patients (%) | Annual event rate, per 100 patient-years units (95% CI) | P-value* | |||||
---|---|---|---|---|---|---|---|
Total (n = 137) | Asymptomatic (n = 64) | Symptomatic (n = 73) | Total (n = 137) | Asymptomatic (n = 64) | Symptomatic (n = 73) | ||
All stroke | 15 (10.9) | 9 (14.1) | 6 (8.2) | 4.86 (2.93–8.06) | 6.02 (3.13–11.58) | 3.77 (1.69–8.38) | 0.367 |
Posterior circulation ischemic stroke | 3 (2.2) | 0 (0) | 3 (4.1) | 0.97 (0.31–3.01) | 0.00 | 1.88 (0.61–5.84) | 0.046 |
Anterior circulation ischemic stroke | 4 (2.9) | 3 (4.7) | 1 (1.4) | 1.30 (0.49–3.45) | 2.01 (0.65–6.23) | 0.63 (0.09–4.45) | 0.277 |
Hemorrhagic stroke | 6 (4.4) | 4 (6.3) | 2 (2.7) | 1.94 (0.87–4.33) | 2.68 (1.00–7.13) | 1.26 (0.31–5.02) | 0.367 |
Unknown stroke | 2 (1.5) | 2 (3.1) | 0 (0) | 0.65 (0.16–2.59) | 1.34 (0.33–5.35) | 0.00 | 0.088 |
Unstable angina/myocardial infarction | 4 (2.9) | 2 (3.1) | 2 (2.7) | 1.30 (0.49–3.45) | 1.34 (0.33–5.35) | 1.26 (0.31–5.02) | 0.949 |
Vascular death | 4 (2.9) | 2 (3.1) | 2 (2.7) | 1.30 (0.49–3.45) | 1.34 (0.33–5.35) | 1.26 (0.31–5.02) | 0.949 |
Composite cardiovascular outcome | 21 (15.3) | 11 (17.2) | 10 (13.7) | 6.80 (4.43–10.43) | 7.36 (4.08–13.30) | 6.28 (3.38–11.66) | 0.714 |
Non–vascular death | 14 (10.2) | 8 (12.5) | 6 (8.2) | 4.53 (2.69–7.66) | 5.36 (2.68–10.71) | 3.77 (1.69–8.38) | 0.512 |
Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|
Model 1 | Model 2 | |||||
Hazard ratio (95% CI) | P-value | Hazard ratio (95% CI) | P-value | Hazard ratio (95% CI) | P-value | |
Age (per 1 year) | 1.01 (0.97–1.05) | 0.720 | 1.00 (0.95–1.06) | 0.893 | - | |
Sex, male | 0.95 (0.40–2.23) | 0.901 | 0.77 (0.22–2.70) | 0.678 | 0.83 (0.34–2.05) | 0.685 |
Hypertension | 2.27 (0.66–7.75) | 0.181 | 2.10 (0.56–7.82) | 0.271 | - | |
Diabetes | 2.21 (0.88–5.55) | 0.082 | 1.89 (0.70–5.11) | 0.208 | - | |
Hyperlipidemia | 1.32 (0.56–3.14) | 0.522 | 1.31 (0.52–3.33) | 0.570 | 1.54 (0.64–3.72) | 0.340 |
Atrial fibrillation | 1.39 (0.31–6.32) | 0.669 | 1.56 (0.24–10.24) | 0.642 | 1.19 (0.23–6.10) | 0.837 |
Smoking | 1.19 (0.49–2.90) | 0.697 | 1.52 (0.40–5.77) | 0.538 | - | |
Previous stroke history | 1.33 (0.51–3.44) | 0.557 | 1.40 (0.51–3.82) | 0.516 | - | |
Coronary arterial disease | 1.26 (0.45–3.59) | 0.661 | 0.99 (0.31–3.17) | 0.984 | - | |
Peripheral arterial disease | 4.99 (1.13–22.0) | 0.034 | 8.29 (0.92–74.52) | 0.059 | - | |
ESRS (per 1) | 1.38 (1.01–1.88) | 0.045 | - | 1.46 (1.02–2.08) | 0.036 | |
Symptomatic stenosis of vertebral artery origin* | 0.99 (0.41–2.39) | 0.978 | 1.09 (0.40–2.95) | 0.869 | 1.04 (0.40–2.74) | 0.935 |
Concurrent vertebrobasilar stenosis‡
| 1.61 (0.67–3.90) | 0.287 | 1.12 (0.39–3.21) | 0.837 | 1.35 (0.52–3.55) | 0.540 |
Concurrent carotid stenosis‡
| 0.90 (0.30–2.68) | 0.848 | 0.41 (0.89–1.91) | 0.256 | 0.65 (0.21–2.06) | 0.467 |
Discussion
CE-MRA for the evaluation of VAO
Prevalence of VAO stenosis
Low risk of posterior circulation ischemic stroke in patients with VAO stenosis
Vertebral artery origin stenosis (n = 137) | Acute lacunar infarcts (n = 171) | P-value | |
---|---|---|---|
Age, years (mean ± SD) | 70.4 ± 10.3 | 63.8 ± 11.5 | < 0.001 |
Male (n,%) | 73 (53.3) | 97 (56.7) | 0.566 |
Hypertension (n,%) | 96 (70.1) | 119 (69.6) | 1.000 |
Diabetes (n,%) | 66 (48.2) | 75 (43.9) | 0.491 |
Hyperlipidemia (n,%) | 56 (40.9) | 57 (33.3) | 0.191 |
Atrial fibrillation (n,%) | 6. (4.4) | 5 (2.9) | 0.547 |
Smoking (n,%) | 61 (44.5) | 90 (52.6) | 0.170 |
Previous stroke history (n,%) | 34 (24.8) | 41 (24.0) | 0.894 |
Coronary arterial disease | 27 (19.7) | 41 (24.4) | 0.337 |
Peripheral arterial disease | 5 (3.6) | 6 (3.6) | 1.000 |
ESRS (mean ± SD) | 3.2 ± 1.5 | 2.9 ± 1.5 | 0.126 |
ESRS > 3 | 52 (38.0) | 58 (33.9) | 0.475 |
Annual event rate, per 100 patient-years units (95% CI) | P-value | ||
---|---|---|---|
Vertebral artery origin stenosis (n = 137) | Acute lacunar infarcts (n = 169) | ||
All stroke | 4.86 (2.93–8.06) | 3.38 (1.41–8.13) | 0.486 |
Unstable angina/myocardial infarction | 1.30 (0.49–3.45) | 2.71 (1.02–7.21) | 0.293 |
Vascular death | 1.30 (0.49–3.45) | 1.35 (0.34–5.41) | 0.960 |
Composite cardiovascular outcome | 6.80 (4.43–10.43) | 6.77 (3.64–12.58) | 0.990 |