title: Hemodynamic Features of Symptomatic Vertebrobasilar Disease.
abstract: OBJECTIVE
  Atherosclerotic vertebrobasilar disease is an important cause of posterior circulation stroke. To examine the role of hemodynamic compromise, a prospective multicenter study, Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS), was conducted. Here, we report clinical features and vessel flow measurements from the study cohort.
  
  
  METHODS
  Patients with recent vertebrobasilar transient ischemic attack or stroke and ≥50% atherosclerotic stenosis or occlusion in vertebral or basilar arteries (BA) were enrolled. Large-vessel flow in the vertebrobasilar territory was assessed using quantitative MRA.
  
  
  RESULTS
  The cohort (n=72; 44% women) had a mean age of 65.6 years; 72% presented with ischemic stroke. Hypertension (93%) and hyperlipidemia (81%) were the most prevalent vascular risk factors. BA flows correlated negatively with percentage stenosis in the affected vessel and positively to the minimal diameter at the stenosis site (P<0.01). A relative threshold effect was evident, with flows dropping most significantly with ≥80% stenosis/occlusion (P<0.05). Tandem disease involving the BA and either/both vertebral arteries had the greatest negative impact on immediate downstream flow in the BA (43 mL/min versus 71 mL/min; P=0.01). Distal flow status assessment, based on an algorithm incorporating collateral flow by examining distal vessels (BA and posterior cerebral arteries), correlated neither with multifocality of disease nor with severity of the maximal stenosis.
  
  
  CONCLUSIONS
  Flow in stenotic posterior circulation vessels correlates with residual diameter and drops significantly with tandem disease. However, distal flow status, incorporating collateral capacity, is not well predicted by the severity or location of the disease.
authors.affiliation: From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.). hanjani@uic.edu.
authors.forename: Sepideh
authors.initials: S
authors.lastname: Amin-Hanjani
authors.affiliation: From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).
authors.forename: Xinjian
authors.initials: X
authors.lastname: Du
authors.affiliation: From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).
authors.forename: Linda
authors.initials: L
authors.lastname: Rose-Finnell
authors.affiliation: From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).
authors.forename: Dilip K
authors.initials: DK
authors.lastname: Pandey
authors.affiliation: From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).
authors.forename: DeJuran
authors.initials: D
authors.lastname: Richardson
authors.affiliation: From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).
authors.forename: Keith R
authors.initials: KR
authors.lastname: Thulborn
authors.affiliation: From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.affiliation: From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Zipfel
authors.affiliation: From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).
authors.forename: Frank L
authors.initials: FL
authors.lastname: Silver
authors.affiliation: From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).
authors.forename: Scott E
authors.initials: SE
authors.lastname: Kasner
authors.affiliation: From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).
authors.forename: Victor A
authors.initials: VA
authors.lastname: Aletich
authors.affiliation: From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).
authors.forename: Louis R
authors.initials: LR
authors.lastname: Caplan
authors.affiliation: From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).
authors.forename: Colin P
authors.initials: CP
authors.lastname: Derdeyn
authors.affiliation: From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).
authors.forename: Philip B
authors.initials: PB
authors.lastname: Gorelick
authors.affiliation: From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).
authors.forename: Fady T
authors.initials: FT
authors.lastname: Charbel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*
keywords: magnetic resonance angiography; magnetic resonance imaging; regional blood flow; stroke; vertebrobasilar ischemia