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Research ArticleEXTRACRANIAL VASCULAR
Open Access

Association of Left Vertebral Artery Hypoplasia with Posterior Circulation Stroke and the Functional Outcome of Patients with Atrial Fibrillation–Related Cardioembolic Stroke

J.-H. Bae, J.-C. Ryu, S.H. Ha, B.J. Kim, D.-W. Kang, S.U. Kwon, J.-S. Kim and J.Y. Chang
American Journal of Neuroradiology December 2022, DOI: https://doi.org/10.3174/ajnr.A7738
J.-H. Bae
aFrom the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, Seoul, Korea
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J.-C. Ryu
aFrom the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, Seoul, Korea
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S.H. Ha
aFrom the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, Seoul, Korea
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B.J. Kim
aFrom the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, Seoul, Korea
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D.-W. Kang
aFrom the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, Seoul, Korea
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S.U. Kwon
aFrom the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, Seoul, Korea
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J.-S. Kim
bDepartment of Neurology (J.-S.K.), Gangneung Asan Hospital, Gangneung, Korea
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J.Y. Chang
aFrom the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, Seoul, Korea
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  • FIG 1.
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    FIG 1.

    Measuring the diameter of the VA. The diameter of each VA was calculated as the average of the measurements made at 3 consecutive points, spaced 3 mm apart, starting from the vertebrobasilar junction.

  • FIG 2.
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    FIG 2.

    Basilar artery occlusion in a patient with left VAH (A) showing right posterior inferior cerebellar artery infarction due to cardioembolism (B), whose 3-month mRS was 4. Follow-up MRA shows a recanalized basilar artery (C).

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    Table 1:

    Characteristics of patients with cardioembolic stroke with atrial fibrillation with left VA hypoplasia and othersa

    Total (n = 407)Left VAH (n = 45)Others (n = 362)P Value
    Age (yr)73.3 (SD, 10.5)74.9 (SD, 10.1)73.1 (SD, 10.5).276
    Female sex196 (48.2)25 (62.2)160 (46.4).045
    Hypertension279 (68.6)35 (77.8)244 (67.4).157
    Diabetes mellitus113 (27.8)15 (33.3)98 (27.1).376
    Hyperlipidemia129 (31.7)11 (24.4)118 (32.6).268
    Ischemic heart disease80 (19.7)6 (13.3)74 (20.4).258
    History of stroke107 (26.3)9 (20.0)98 (27.1).309
    Current smoker110 (27.0)11 (24.4)99 (27.3).679
    Initial NIHSS6.0 (2.0–13.0)6.0 (2.5–11.5)6.0 (2.0–13.0).886
    Lesion location
     Anterior circulation293 (72.0)23 (51.1)270 (74.6).001
     Posterior circulation92 (22.6)19 (42.2)73 (20.2).001
     Both22 (5.4)3 (6.7)19 (5.2).692
    BAO15 (3.7)5 (11.1)10 (2.8).005
    3-Month mRS2.0 (0.3–4.0)3.0 (1.0–5.0)2.0 (0.0–4.0).067
    3-Month mRS 0–2234 (57.5)20 (44.4)214 (59.1).060
    3-Months mRS 0–3281 (69.0)25 (55.6)256 (70.7).038
    • Note:—BAO indicates basilar artery occlusion.

    • ↵a Results are presented as number and percentage, mean, or median (25th–75th percentile).

    • View popup
    Table 2:

    Characteristics of patients with cardioembolic stroke with PICA territory infarction contralateral to VAHa

    VAHRight PICA Territory Infarction (n = 21)Left PICA Territory Infarction (n = 28)P Value
    Left6 (28.6)1 (3.6).013
    Right5 (23.8)9 (32.1).523
    Symmetric10 (47.6)18 (64.3).243
    • ↵a Results are presented as number and percentage.

    • View popup
    Table 3:

    Characteristics of patients with atrial fibrillation–related cardioembolic stroke with good functional outcome (mRS 0–2) versus poor functional outcome (mRS 3–6)a

    3-Month mRS 0–2 (n = 234)3-Month mRS 3–6 (n = 173)P Value
    Age (yr)70.8 (SD, 9.8)76.7 (SD, 10.5)<.001
    Female sex92 (41.5)93 (57.2).002
    Hypertension151 (64.5)128 (74.0).042
    Diabetes mellitus51 (22.8)62 (35.8).002
    Hyperlipidemia79 (33.8)50 (28.9).298
    Ischemic heart disease49 (20.9)31 (17.9).448
    History of stroke45 (19.2)62 (35.8)<.001
    Current smoker75 (32.1)35 (20.2).008
    Initial NIHSS3.0 (1.0–7.0)13.0 (6.0–17.0)<.001
    VAH
     Right59 (25.2)40 (23.1).627
     Left20 (8.5)25 (14.5).060
     Symmetric155 (66.2)108 (62.4).427
    Lesion location
     Anterior circulation164 (70.1)129 (74.6).260
     Posterior circulation59 (25.2)33 (19.1).108
     Both11 (4.7)11 (6.4).465
    BAO4 (1.7)11 (6.4).014
    • Note:—BAO indicates basilar artery occlusion.

    • ↵a Results presented as number and percentage, mean, or median (25th–75th percentile).

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Cite this article
J.-H. Bae, J.-C. Ryu, S.H. Ha, B.J. Kim, D.-W. Kang, S.U. Kwon, J.-S. Kim, J.Y. Chang
Association of Left Vertebral Artery Hypoplasia with Posterior Circulation Stroke and the Functional Outcome of Patients with Atrial Fibrillation–Related Cardioembolic Stroke
American Journal of Neuroradiology Dec 2022, DOI: 10.3174/ajnr.A7738

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Association of Left Vertebral Artery Hypoplasia with Posterior Circulation Stroke and the Functional Outcome of Patients with Atrial Fibrillation–Related Cardioembolic Stroke
J.-H. Bae, J.-C. Ryu, S.H. Ha, B.J. Kim, D.-W. Kang, S.U. Kwon, J.-S. Kim, J.Y. Chang
American Journal of Neuroradiology Dec 2022, DOI: 10.3174/ajnr.A7738
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