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J Neurol Neurosurg Psychiatry 2009;80:1087-1092 doi:10.1136/jnnp.2008.169805
  • Research paper

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

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  1. J M Hong1,
  2. C-S Chung2,
  3. O Y Bang2,
  4. S W Yong1,
  5. I S Joo1,
  6. K Huh1
  1. 1
    Department of Neurology, Ajou University Medical Centre, Suwon, South Korea
  2. 2
    Department of Neurology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
  1. Correspondence to Dr J M Hong, Department of Neurology, Ajou University Medical Centre, Ajou University School of Medicine, 5 San, Woncheon-dong, Yongtong-gu, Suwon-si, Kyunggi-do, 442-749, South Korea; dacda{at}hanmail.net
  • Received 5 December 2008
  • Revised 23 February 2009
  • Accepted 2 April 2009
  • Published Online First 3 May 2009

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.

Footnotes

  • See Editorial Commentary, p 1057

  • Competing interests None.

  • Ethics approval This study was approved by the Institutional Review Board at Ajou University Hospital.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

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