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Advances in imaging research of vertebral artery hypoplasia and its relationship with posterior circulation ischemic stroke
SU Huirong  SONG Jianxun  HUANG Tengda 

Cite this article as: SU H R, SONG J X, HUANG T D. Advances in imaging research of vertebral artery hypoplasia and its relationship with posterior circulation ischemic stroke[J]. Chin J Magn Reson Imaging, 2023, 14(6): 119-123. DOI:10.12015/issn.1674-8034.2023.06.021.

[Abstract] Vertebral artery hypoplasia is a congenital vascular variation of the posterior cerebral circulation system, but more and more studies have found that it may be a risk factor for posterior circulation ischemic stroke. Most previous studies investigate the relationship between vertebral artery hypoplasia and posterior circulation stroke based on the traditional lumen imaging technology. But they ignore the necessity of differentiating vertebral artery hypoplasia from atherosclerosis in stroke. High-resolution vessel wall imaging has great advantages in showing the structural changes of vessel wall and revealing the relationship. This article reviews the diagnosis and incidence of vertebral artery hypoplasia, imaging evaluation methods, and its relationship with posterior circulation ischemic stroke, in order to improve clinical attention and further understanding of vertebral artery hypoplasia and reduce the occurrence of related adverse events.
[Keywords] vertebral artery hypoplasia;ischemic stroke;magnetic resonance imaging;high resolution vessel wall imaging

SU Huirong1   SONG Jianxun2*   HUANG Tengda1  

1 Guangdong Medical University, Zhanjiang 524023, China

2 Shenzhen Baoan Clinical Medical College of Guangdong Medical University, Room of MR, Shenzhen Baoan People's Hospital, Shenzhen 518100, China

Corresponding author: Song JX, E-mail:

Conflicts of interest   None.

ACKNOWLEDGMENTS Shenzhen Science and Technology Innovation Plan Project Sustainable Development Special Project (No. KCXFZ 202002011010360).
Received  2022-09-30
Accepted  2023-05-30
DOI: 10.12015/issn.1674-8034.2023.06.021
Cite this article as: SU H R, SONG J X, HUANG T D. Advances in imaging research of vertebral artery hypoplasia and its relationship with posterior circulation ischemic stroke[J]. Chin J Magn Reson Imaging, 2023, 14(6): 119-123. DOI:10.12015/issn.1674-8034.2023.06.021.

BAKALARZ M, ROZNIECKI J J, STASIOLEK M. Clinical Characteristics of Patients with Vertebral Artery Hypoplasia[J]. Int J Environ Res Public Health, 2022, 19(15): 9317. DOI: 10.3390/ijerph19159317.
CHUANG Y M, CHAN L, WU H M, et al. The clinical relevance of vertebral artery hypoplasia[J]. Acta Neurol Taiwan, 2012, 21(1): 1-7.
PARK J H, KIM J M, ROH J K. Hypoplastic vertebral artery: frequency and associations with ischaemic stroke territory[J]. J Neurol Neurosurg Psychiatry, 2007, 78(9): 954-958. DOI: 10.1136/jnnp.2006.105767.
MARKUS H S, VAN DER WORP H B, ROTHWELL P M. Posterior circulation ischaemic stroke and transient ischaemic attack: diagnosis, investigation, and secondary prevention[J]. Lancet Neurol, 2013, 12(10): 989-998. DOI: 10.1016/S1474-4422(13)70211-4.
CHI H Y, HSU C F, CHEN A C, et al. Extracranial and Intracranial Ultrasonographic Findings in Posterior Circulation Infarction[J]. J Ultrasound Med, 2018, 37(7): 1605-1610. DOI: 10.1002/jum.14501.
ZHANG D P, REN Y F, ZHANG H L, et al. Effect of vertebral artery hypoplasia on false negative rates in early MRI detection of small posterior circulation infarcts in elderly patients[J]. Chin J Geriatr, 2018, 37(8): 864-869. DOI: 10.3760/cma.j.issn.0254-9026.2018.08.007.
CHEN Y Y, CHAO A C, HSU H Y, et al. Vertebral artery hypoplasia is associated with a decrease in net vertebral flow volume[J]. Ultrasound Med Biol, 2010, 36(1): 38-43. DOI: 10.1016/j.ultrasmedbio.2009.08.012.
THIERFELDER K M, BAUMANN A B, SOMMER W H, et al. Vertebral artery hypoplasia: frequency and effect on cerebellar blood flow characteristics[J]. Stroke, 2014, 45(5): 1363-1368. DOI: 10.1161/STROKEAHA.113.004188.
YANG J, SHEN Z, WEN H, et al. The effect of vertebral artery hypoplasia in posterior circulation infarction in young patients[J]. Int J Neurosci, 2016, 126(12): 1092-1096. DOI: 10.3109/00207454.2015.1126716.
ZHANG Q, HUANG L Y, TANG B R, et al. Correlation of vertebral artery hypoplasia with posterior circulation cerebral infarction[J]. Chin J Neuromed, 2017, 16(1):22-27. DOI: 10.3760/cma.j.issn.1671-8925.2017.01.005.
WANG J, MA Q, YANG Z, et al. Feasibility of evaluating the stenosis of intracranial segment in the vertebral artery using neck-brain integrated ultrasound: a comparison with computed tomography angiography and digital subtraction angiography[J]. Ann Transl Med, 2020, 8(18): 1155. DOI: 10.21037/atm-20-5713.
PASAOGLU L. Vertebrobasilar system computed tomographic angiography in central vertigo[J/OL]. Medicine (Baltimore), 2017, 96(12): e6297 [2022-10-23]. DOI: 10.1097/MD.0000000000006297.
MORANI A C, MUBARAK A I, JENSEN C T, et al. CT angiographic evaluation of the V3 vertebral artery course in cases of occipitalized atlas, a study of 25 cases[J]. Clin Imaging, 2021, 71: 69-76. DOI: 10.1016/j.clinimag.2020.11.007.
WANG S, REN W J, ZHENG L, et al. Anatomical Variations of the Vertebral Artery: Analysis by Three-Dimensional Computed Tomography Angiography in Chinese Population[J]. Orthop Surg, 2021, 13(5): 1556-1562. DOI: 10.1111/os.13047.
LIU K, LIU X, SONG H, et al. The assessment of the frequency and arrangement of the subsegmental branches of V3 using computed tomography angiography[J]. Quant Imaging Med Surg, 2021, 11(4): 1284-1291. DOI: 10.21037/qims-20-725.
ZHANG Z Y, ZHOU Z, ZHANG H B, et al. Case report: the etiology of anterior inferior cerebellar artery infarction: what does basi-parallel anatomic scanning magnetic resonance imaging tell us?[J]. BMC Neurol, 2021, 21(1): 299. DOI: 10.1186/s12883-021-02309-2.
LIU J, ZHAO L, YAO L, et al. Basi-parallel anatomic scanning (BPAS-MRI) compared with high-resolution MRI for the diagnosis of vertebrobasilar artery abnormalities[J]. Eur J Radiol, 2020, 123: 108791. DOI: 10.1016/j.ejrad.2019.108791.
GUO A W, GAO P, ZENG F H, et al. The value of combining basi-parallel anatomical scanning and MRA for the diagnosis of intracranial vertebrobasilar artery diseases[J]. J Pract Radiol, 2020, 36(6): 855-858. DOI: 10.3969/j.issn.1002-1671.2020.06.001.
KESAV P, KRISHNAVADANA B, KESAVADAS C, et al. Utility of intracranial high-resolution vessel wall magnetic resonance imaging in differentiating intracranial vasculopathic diseases causing ischemic stroke[J]. Neuroradiology, 2019, 61(4): 389-396. DOI: 10.1007/s00234-019-02157-5.
VRANIC J E, HARTMAN J B, MOSSA-BASHA M. High-Resolution Magnetic Resonance Vessel Wall Imaging for the Evaluation of Intracranial Vascular Pathology[J]. Neuroimaging Clin N Am, 2021, 31(2): 223-233. DOI: 10.1016/j.nic.2021.01.005.
LINDENHOLZ A, VAN DER KOLK A G, ZWANENBURG J J M, et al. The Use and Pitfalls of Intracranial Vessel Wall Imaging: How We Do It[J]. Radiology, 2018, 286(1): 12-28. DOI: 10.1148/radiol.2017162096.
MANDELL D M, MOSSA-BASHA M, QIAO Y, et al. Intracranial Vessel Wall MRI: Principles and Expert Consensus Recommendations of the American Society of Neuroradiology[J]. AJNR Am J Neuroradiol, 2017, 38(2): 218-229. DOI: 10.3174/ajnr.A4893.
GAIGALAITE V, VILIMAS A, OZERAITIENE V, et al. Association between vertebral artery hypoplasia and posterior circulation stroke[J]. BMC Neurol, 2016, 16: 118. DOI: 10.1186/s12883-016-0644-x.
KULYK C, VOLTAN C, SIMONETTO M, et al. Vertebral artery hypoplasia: an innocent lamb or a disguise?[J]. J Neurol, 2018, 265(10): 2346-2352. DOI: 10.1007/s00415-018-9004-7.
PARK J H, ROH J K, KWON H M. Ischemic stroke patterns and hemodynamic features in patients with small vertebrobasilar artery[J]. J Neurol Sci, 2009, 287(1-2): 227-235. DOI: 10.1016/j.jns.2009.07.007.
KATSANOS A H, GIANNOPOULOS S. Increased risk for posterior circulation ischaemia in patients with vertebral artery hypoplasia: A systematic review and meta-analysis[J]. Eur Stroke J, 2017, 2(2): 171-177. DOI: 10.1177/2396987317700540.
HADEMENOS G J, MASSOUD T F. Biophysical mechanisms of stroke[J]. Stroke, 1997, 28(10): 2067-2077. DOI: 10.1161/01.str.28.10.2067.
ZARRINTAN S, IWANAGA J, MOZAFAR M, et al. An Ultrasound Evaluation of the Vertebral Artery in Patients With Vertebral Artery Hypoplasia[J/OL]. Cureus, 2021, 13(5): e15020 [2022-10-26]. DOI: 10.7759/cureus.15020.
ZHANG D P, MA Q K, ZHANG J W, et al. Vertebral artery hypoplasia, posterior circulation infarction and relative hypoperfusion detected by perfusion magnetic resonance imaging semiquantitatively[J]. J Neurol Sci, 2016, 368: 41-46. DOI: 10.1016/j.jns.2016.06.043.
ZHAO W, ZHANG J, MENG Y, et al. Symptomatic Atherosclerotic Non-acute Intracranial Vertebral Artery Total Occlusion: Clinical Features, Imaging Characteristics, Endovascular Recanalization, and Follow-up Outcomes[J]. Front Neurol, 2020, 11: 598795. DOI: 10.3389/fneur.2020.598795.
CHUANG Y M, HUANG Y C, HU H H, et al. Toward a further elucidation: role of vertebral artery hypoplasia in acute ischemic stroke[J]. Eur Neurol, 2006, 55(4): 193-197. DOI: 10.1159/000093868.
LU G F, ZHANG D P, QI J X, et al. Changes and significance of the posterior circulation blood flow and wall shear stress in patients with vertebral artery hypoplasia[J]. Chin J Cerebrovasc Dis, 2019, 16(3): 133-139. DOI: 10.3969/j.issn.1672-5921.2019.03.005.
CHAN P C, HUANG H S, CHEN K W, et al. Low Vertebrobasilar Velocity Is Associated with a Higher Risk of Posterior Circulation Ischemic Lesions[J]. J Clin Med, 2022, 11(5): 1396. DOI: 10.3390/jcm11051396.
Han D, Starikov A, Hartaigh B Ó, et al. Relationship Between Endothelial Wall Shear Stress and High-Risk Atherosclerotic Plaque Characteristics for Identification of Coronary Lesions That Cause Ischemia: A Direct Comparison With Fractional Flow Reserve[J/OL]. J Am Heart Assoc, 2016, 5(12): e004186 [2022-10-23]. DOI: 10.1161/JAHA.116.004186.
GIJSEN F, KATAGIRI Y, BARLIS P, et al. Expert recommendations on the assessment of wall shear stress in human coronary arteries: existing methodologies, technical considerations, and clinical applications[J]. Eur Heart J, 2019, 40(41): 3421-3433. DOI: 10.1093/eurheartj/ehz551.
CHENG C, TEMPEL D, VAN HAPEREN R, et al. Atherosclerotic lesion size and vulnerability are determined by patterns of fluid shear stress[J]. Circulation, 2006, 113(23): 2744-2753. DOI: 10.1161/CIRCULATIONAHA.105.590018.
DHAWAN S S, AVATI NANJUNDAPPA R P, BRANCH J R, et al. Shear stress and plaque development[J]. Expert Rev Cardiovasc Ther, 2010, 8(4): 545-556. DOI: 10.1586/erc.10.28.
DINC Y, OZPAR R, EMIR B, et al. Vertebral artery hypoplasia as an independent risk factor of posterior circulation atherosclerosis and ischemic stroke[J/OL]. Medicine (Baltimore), 2021, 100(38): e27280 [2022-10-23]. DOI: 10.1097/MD.0000000000027280.
HONG J M, CHUNG C S, BANG O Y, et al. Vertebral artery dominance contributes to basilar artery curvature and peri-vertebrobasilar junctional infarcts[J]. J Neurol Neurosurg Psychiatry, 2009, 80(10): 1087-1092. DOI: 10.1136/jnnp.2008.169805.
NGO M T, KWAK H S, CHUNG G H. Change in basilar artery length and bending according to aging and vertebral artery dominance: A longitudinal study[J]. Sci Rep, 2020, 10(1): 8904. DOI: 10.1038/s41598-020-65682-x.
ZHANG D P, ZHANG S L, ZHANG J W, et al. Basilar artery bending length, vascular risk factors, and pontine infarction[J]. J Neurol Sci, 2014, 338(1-2): 142-147. DOI: 10.1016/j.jns.2013.12.037.
ZHU W, WANG Y F, DONG X F, et al. Study on the correlation of vertebral artery dominance, basilar artery curvature and posterior circulation infarction[J]. Acta Neurol Belg, 2016, 116(3): 287-293. DOI: 10.1007/s13760-015-0570-5.
DENG S, ZHENG J, WU Y, et al. Geometrical characteristics associated with atherosclerotic disease in the basilar artery: a magnetic resonance vessel wall imaging study[J]. Quant Imaging Med Surg, 2021, 11(6): 2711-2720. DOI: 10.21037/qims-20-1291.
KIM B J, KIM H Y, JHO W, et al. Asymptomatic Basilar Artery Plaque Distribution and Vascular Geometry[J]. J Atheroscler Thromb, 2019, 26(11): 1007-1014. DOI: 10.5551/jat.47365.
YU J, ZHANG S, LI M L, et al. Relationship between the geometry patterns of vertebrobasilar artery and atherosclerosis[J]. BMC Neurol, 2018, 18(1): 83. DOI: 10.1186/s12883-018-1084-6.
GAIGALAITE V, DEMENTAVICIENE J, VILIMAS A, et al. Association between the posterior part of the circle of Willis and the vertebral artery hypoplasia[J/OL]. PLoS One, 2019, 14(9): e021322 [2022-10-26]. DOI: 10.1371/journal.pone.0213226.
HSU C F, CHEN K W, SU C H, et al. Bilateral Vertebral Artery Hypoplasia and Fetal-Type Variants of the Posterior Cerebral Artery in Acute Ischemic Stroke[J]. Front Neurol, 2021, 12: 582149. DOI: 10.3389/fneur.2021.582149.

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