Evaluation of hemodynamic characteristics in posterior circulation infarction patients with vertebral artery dominance by color doppler flow imaging and transcranial doppler sonography

Relationship between subclavian artery stenosis lesions and posterior circulation infarction: A preliminary study

OBJECTIVE

To investigate the correlation between subclavian steal syndrome and posterior circulation infarction using magnetic resonance imaging.

METHODS

A total of 294 patients diagnosed with subclavian steal syndrome using carotid Doppler ultrasonography were retrospectively included. According to the magnetic resonance imaging results, they were divided into posterior circulation infarction group and non- posterior circulation infarction group. Clinical indicators and carotid Doppler ultrasound parameters of patients were collected, and they were screened to establish a multiple logistic regression model. Receiver operating characteristic curve analysis of the established multiple logistic regression model was performed, and the area under the curve was calculated to evaluate the predictive efficiency of the model.

RESULTS

After statistical analysis of all parameters of the two groups of patients, a total of 10 parameters were included in multiple logistic regression to establish a model. The results showed a correlation between posterior circulation infarction and subclavian artery occlusion, grade III subclavian steal syndrome, gender, vulnerable plaques, National Institutes of Health Stroke Scale score, and age. After the receiver operating characteristic curve analysis of the model, the area under the curve for the multiple logistic regression model was 0.773.

CONCLUSION

The multiparameter composite model based on clinical baseline data and carotid Doppler ultrasonography parameters can effectively predict posterior circulation infarction and offer novel insight for clinical diagnosis.

Retrospective Cohort Angiographic Analysis of Vertebral Artery Dominance, Stenosis Patterns, and Demographic Correlations

Background

Differences in dominance and stenosis in the complex vertebral artery (VA) network pose challenges in diagnosing and treating cerebrovascular diseases crucial for brain nutrition. This research examines these intricacies, highlighting the importance of detailed diagnosis and treatment methods.

Objective

To analyze the prevalence of the dominant VA, evaluate the influence of gender and age on steno-occlusion, and explore the correlation between the dominant VA and stenosed VA segments.

Methods

A retrospective study of 249 angiograms from patients with VA stenosed at King Abdullah University Hospital between August 2019 and December 2022. The patients presenting symptoms of vertigo, migraines, headaches, or transient ischemic attacks (TIA) were included, 182 cases were classified based on VA dominance and stenosis severity. The data were analyzed using IBM SPSS 27.

Results

Out of the 182 participants, 64.8% were male, with an average age of 61.3 years and 35.2% were female. The prevalence of stenosis was distributed as follows: 26.4% mild, 44.0% moderate, and 29.7% severe. Statistically significant correlations were observed between hypertension, smoking, hyperlipidemia, and the degree of stenosis (p < 0.05), but not with diabetes. The prevalence of left vertebral artery (VA) dominance was found to be 41.1%. Additionally, there was no gender connection observed in the distribution of steno-occlusion (p = 0.434). There is no notable correlation between the degree of stenosis and the dominant vertebral artery (p > 0.05).

Conclusion

Angiographic findings reveal the complex relationship between the dominance of the VA, patterns of stenosis, and demographic factors. Individuals with a dominant VA had a greater likelihood of developing stenosis on the opposite non-dominant side. The high occurrence of severe stenosis highlights the need for tailored diagnostic and treatment approaches. Understanding vertebral stenosis as a multifaceted interaction of demographic, lifestyle, and anatomical variables is essential for enhancing treatment strategies.

Characterization of Cerebral Hemodynamics with TCD in Patients Undergoing VA-ECMO and VV-ECMO: a Prospective Observational Study

BACKGROUND

Extracorporeal membrane oxygenation has a high risk of acute brain injury and resultant mortality. Transcranial Doppler characterizes cerebral hemodynamics in real time, but limited data exist on its interpretation in ECMO. Here, we report TCD mean flow velocity and pulsatility index in a large ECMO population.

METHODS

This was a prospective cohort study at a tertiary care center. The patients were adults on venoarterial ECMO or venovenous ECMO undergoing TCD studies.

RESULTS

A total of 135 patients underwent a total of 237 TCD studies while on VA-ECMO (n = 95, 70.3%) or VV-ECMO (n = 40, 29.6%). MFVs were captured reliably (approximately 90%) and were similar to a published healthy cohort in all vessels except the internal carotid artery. Presence of a recordable PI was strongly associated with ECMO mode (57% in VA vs. 95% in VV, p < 0.001). Absence of TCD pulsatility was associated with intraparenchymal hemorrhage (14.7 vs. 1.6%, p = 0.03) in VA-ECMO patients.

CONCLUSIONS

Transcranial Doppler analysis in a single-center cohort of VA-ECMO and VV-ECMO patients demonstrates similar MFVs and PIs. Absence of PIs was associated with a higher frequency of intraparenchymal hemorrhage and a composite bleeding event. However, cautious interpretation and external validation is necessary for these findings with a multicenter study with a larger sample size.

An association between vertebral artery dominance and steno-occlusion of the vertebral artery segments: A retrospective angiographic study

OBJECTIVES

This study investigated whether there was a relationship between steno-occlusion of the vertebral artery (VA) segments and the dominant VA side.

MATERIALS AND METHODS

Angiography results of 215 patients (146 men; 69 women) were retrospectively analyzed in this study. The patients were divided into three groups: dominant, non-dominant and co-dominant. These groups were compared according to the presence of steno-occlusion in the vertebral artery segments. The results were evaluatedusing X², Mann-Whitney U and Kruskal-Wallis tests. For correlation analysis, Spearman's Rho test was used.

RESULTS

The findings showed that 55 of 215 patients (25.6%) had a right dominant VA, and 103 (47.9%) had left dominant VA. There was no significant relationship between dominance and age or gender (p > 0.05). More vertebral artery stenosis (VAS) was found on the dominant side. However, a significant relationship only in the right dominant V1 segment (p = 0.044) was noticed. Hypoplastic VA was detected in 13 patients (6%). Most of the VAs (98.4%, n = 423) arose from the subclavian artery.

CONCLUSIONS

In conclusion, we found more vertebral artery stenosis on the dominant side than the co-dominant side, especially on the origin of the vertebral arteries. However, it was only significant on the right dominant V1 segment, regardless of age and gender of the patients (p > 0.05).