Vertebrobasilar Artery Geometry and Basilar Artery Plaques: A High-Resolution Magnetic Resonance Imaging Study

Abstract

Background Atherosclerotic plaques are often present in regions with complicated flow patterns. Vascular morphology plays a role in hemodynamics. In this study, we investigate the relationship between the geometry of the vertebrobasilar artery system and the basilar artery (BA) plaque prevalence. Methods We enrolled 290 patients with posterior circulation ischemic stroke. We distinguished four configurations of the vertebrobasilar artery: Walking, Tuning Fork, Lambda, and No Confluence. The diameter of the vertebral artery (VA) and the number of bends in the intracranial VA segment was assessed using three-dimensional time-of-flight magnetic resonance angiography. We differentiated between multi-bending (≥ 3 bends) and oligo-bending (< 3 bends) VAs. High-resolution magnetic resonance imaging was used to evaluate BA plaques. Logistic regression models examined the relationship between the geometry type and BA plaque prevalence. Results After adjusting for sex, age, body mass index ≥ 28, hypertension, and diabetes mellitus, the Walking, Lambda, and No Confluence geometries were associated with the presence of BA plaque. Patients with multi-bending VAs in both the Walking (71.43%, P = 0.003) and Lambda group (40.43%, P = 0.018) had more plaques compared to patients with oligo-bending VAs in these groups. In the Lambda group, the diameter difference between the VAs was larger in patients with BA plaques than that in patients without BA plaques (1.4 mm vs. 0.9 mm, P < 0.001). Conclusions The Walking, Lambda, and No Confluence geometry, ≥ 3 bends in the VAs, and a large diameter difference between the VAs were associated with the presence of BA plaque.