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. 2009 Oct;80(10):1087-92.
doi: 10.1136/jnnp.2008.169805. Epub 2009 May 3.

Vertebral artery dominance contributes to basilar artery curvature and peri-vertebrobasilar junctional infarcts

J M Hong  1 , C-S Chung, O Y Bang, S W Yong, I S Joo, K Huh
Affiliations

Vertebral artery dominance contributes to basilar artery curvature and peri-vertebrobasilar junctional infarcts

J M Hong et al. J Neurol Neurosurg Psychiatry. 2009 Oct.

Abstract

Objectives: The diameters of the vertebral arteries (VAs) are very often unequal. Therefore, this study investigated if unequal VA flow contributes to the development of basilar artery (BA) curvature and if it is a link to the laterality of pontine or cerebellar infarcts occurring around the vertebrobasilar junction.

Methods: Radiological factors were analysed (infarct laterality, VA dominance, BA curvature and their directional relationships) in 91 patients with acute unilateral pontine or posterior inferior cerebellar artery (PICA) territory infarcts. The "dominant" VA side was defined as either that the VA was larger in diameter or the VA was connected with the BA in more of a straight line, if both VAs looked similar in diameter on CT angiography. Multiple regression analysis was performed to predict moderate to severe BA curvature.

Results: The dominant VA was more frequent on the left side (p<0.01). Most patients had an opposite directional relationship between the dominant VA and BA curvature (p<0.01). Pontine infarcts were opposite to the side of BA curvature (p<0.01) and PICA infarcts were on the same side as the non-dominant VA side (p<0.01). The difference in VA diameters was the single independent predictor for moderate to severe BA curvature (OR per 1 mm, 2.70; 95% CI 1.22 to 5.98).

Conclusions: Unequal VA flow is an important haemodynamic contributor of BA curvature and development of peri-vertebrobasilar junctional infarcts.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Overlapping contour maps of peri-vertebrobasilar junctional infarcts. Paramedian region of the left mid-pons was the most affected site for post-vertebrobasilar junctional infarcts (ie, pontine infarcts) whereas the right inferior medial region in the cerebellum was the most affected site for the ischaemic infarcts around the pre-vertebrobasilar junction (ie, posterior inferior cerebellar artery infarcts).
Figure 2
Figure 2
Directional relationships according to BA angulation, VA dominancy and peri-vertebral junctional infarcts (ie, pontine and PICA infarcts). BA, basilar artery, PICA, posterior inferior cerebellar artery; VA, vertebral artery.
Figure 3
Figure 3
Schematic illustrations of the pathophysiological process of peri-vertebral junctional infarcts: possible changes in vetebrobasilar vessels under the condition of an unequal VA flow. BA, basilar artery, VA, vertebral artery.
See this image and copyright information in PMC

Comment in

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