Basilar artery bending length, vascular risk factors, and pontine infarction
Introduction
Using the noninvasive cerebrovascular examination methods magnetic resonance angiography (MRA) and computed tomography angiography (CTA), it has been discovered that—by comparison to the standard picture of a straight-line vessel at the anatomical midline—basilar arteries (BAs) exhibit different degrees of bending in cerebrovascular disease patients and healthy subjects [1]. Furthermore, clinical and radiological physicians have, to a large extent, focused on vascular stenosis or occlusion while generally ignoring the presence of vascular curvature during the diagnosis and treatment of cerebrovascular diseases [2]. Because of the importance of the BA in supplying blood to the brain, and given that BA bending among the general populace is common, it has, therefore, been suggested that BA bending should be given more attention in dealing with cases of posterior circulation infarction [3], [4]. However, the underlying reason for BA bending is unclear, and its association with atherosclerosis and ischemic stroke is controversial [5]. Recently, there has been a much greater concern among medical researchers with the occurrence of BA dolichoectasia (BAD), and the suggestion that BAD is related to posterior circulation ischemic stroke [6], [7], [8]; on the other hand, there are, many BA tortuosity cases that are not attributable to BAD. Unfortunately, BA bending, which is linked to ischemic cerebrovascular diseases, has been less well studied [1], [3].
Previous studies on this topic have applied several methods for evaluating BA bending [9], [10]. In this research, BA length (BAL) [1] and bending length (BL) were measured to investigate the relationships between age, gender, and vertebral artery (VA) dominance. BAL and BL were regarded as more convenient, reliable evaluators of BA bending. Based on these findings, it was reasonable to surmise that changes of BAL and BL contribute to posterior circulation infarction, especially of the pons. For the purpose of elucidating the relationship among BL, vascular risk factors, and pontine infarction, the present study was based on high-field-strength MRA to achieve reliably well-defined BA imaging. A cross-sectional, case–control study design was used to reveal the effect of BA bending together with vascular risk factors in patients with pontine infarction.
Section snippets
Patients
From June 2009 to October 2012, 217 acute pontine infarction patients admitted to the Department of Neurology of Zhengzhou People's Hospital (China) were identified; these patients had been diagnosed using magnetic resonance (MR) diffusion-weighted imaging (DWI). On the basis of the Chinese ischemic stroke subclassification (CISS), 97 of these patients were classified as having either small artery disease or infarcts of undetermined etiology [11]; ultimately, 88 of these 97 patients with
General demographic and radiological findings
Of the 46 cases in the BA bending group, occlusion of the paramedian artery occurred in 19 cases, of the short circumflex artery in 12 cases, of the long circumflex artery in 9 cases, and of the two-arterial innervation region in 6 patients. Thirty-two of these 46 patients had infarction located on the side contralateral to BA bending and 14 patients on the side ipsilateral to the bending. A C-type bending was observed in 33 cases and S-type bending in 8 cases. BA bending to the right was seen
Discussion
Our study explored the association among BA bending (not BAD), vascular risk factors and pontine infarction with small artery disease or infarct of undetermined etiology according to the Chinese ischemic stroke subclassification. Infarction was typically located on the contralateral side with respect to the bending in BA-bending pontine infarct patients. According to one vascular remodeling theory, it is presumed that VAs are typically asymmetric with the BA gradually curving in the opposite
Conflict of interest statement
None.
Acknowledgments
The authors wish to thank the Department of Radiology for providing the imaging data. This study was supported by a grant (No. 121PPTGG494-12) from the Bureau of Science and Technology of Zhengzhou City and a grant (201303224) of Medical Science and Technology from the Health Department of Henan Province.
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Dao-pei Zhang & Shu-ling Zhang contributed equally to the study, and are co-first authors of the article.