Journal article
Natural History of Hemodynamics in Vertebrobasilar Disease: Temporal Changes in the VERiTAS Study Cohort
Stroke (1970), Vol.51(11), pp.3295-3301
11/2020
DOI: 10.1161/STROKEAHA.120.029909
PMCID: PMC7606530
PMID: 33032489
Abstract
The role of regional hypoperfusion as a contributor to stroke risk in atherosclerotic vertebrobasilar disease has recently been confirmed by the observational VERiTAS (Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke) Study. We examined the stability of hemodynamic status over time and its relationship to stroke risk in patients from this prospective cohort.
VERiTAS enrolled patients with recently symptomatic ≥50% atherosclerotic stenosis/occlusion of vertebral and/or basilar arteries. Large vessel flow in the vertebrobasilar territory was assessed using quantitative magnetic resonance angiography, and patients were designated as low or normal flow based on distal territory regional flow, incorporating collateral capacity. Patients underwent standard medical management and follow-up for primary outcome event of vertebrobasilar territory stroke. Quantitative magnetic resonance angiography imaging was repeated at 6, 12, and 24 months. Flow status over time was examined relative to baseline and relative to subsequent stroke risk using a cause-specific proportional hazard model, with flow status treated as a time-varying covariate. Mean blood pressure was examined to assess for association with changes in flow status.
Over 19±8 months of follow-up, 132 follow-up quantitative magnetic resonance angiography studies were performed in 58 of the 72 enrolled patients. Of the 13 patients with serial imaging who had low flow at baseline, 7 (54%) had improvement to normal flow at the last follow-up. Of the 45 patients who had normal flow at baseline, 3 (7%) converted to low flow at the last follow-up. The mean blood pressure did not differ in patients with or without changes in flow status. The time-varying flow status remained a strong predictor of subsequent stroke (hazard ratio, 10.3 [95% CI, 2.2-48.7]).
There is potential both for improvement and worsening of hemodynamics in patients with atherosclerotic vertebrobasilar disease. Flow status, both at baseline and over time, is a risk factor for subsequent stroke, thus serving as an important prognostic marker. Registration: URL: https://clinicaltrials.gov. Unique identifier: NCT00590980.
Details
- Title: Subtitle
- Natural History of Hemodynamics in Vertebrobasilar Disease: Temporal Changes in the VERiTAS Study Cohort
- Creators
- Sepideh Amin-Hanjani - Department of Neurosurgery (S.A.-H., A.P.S., X.D., L.R.-F., F.T.C.), University of Illinois at ChicagoAlfred P See - Department of Neurosurgery (S.A.-H., A.P.S., X.D., L.R.-F., F.T.C.), University of Illinois at ChicagoXinjian Du - Department of Neurosurgery (S.A.-H., A.P.S., X.D., L.R.-F., F.T.C.), University of Illinois at ChicagoLinda Rose-Finnell - Department of Neurosurgery (S.A.-H., A.P.S., X.D., L.R.-F., F.T.C.), University of Illinois at ChicagoDilip K Pandey - Department of Neurology and Rehabilitation (D.K.P.), University of Illinois at ChicagoYi-Fan Chen - Center for Clinical and Translational Science (Y.-F.C.), University of Illinois at ChicagoMitchell S V Elkind - Departments of Neurology and Epidemiology, Columbia University, New York (M.S.V.E.)Gregory J Zipfel - Departments of Neurosurgery and Neurology, Washington University in St Louis, MO (G.J.Z.)David S Liebeskind - Department of Neurology, UCLA (University of California, Los Angeles) (D.S.L.)Frank L Silver - Division of Neurology, Department of Medicine, University of Toronto, ON, Canada (F.L.S.)Scott E Kasner - Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.)Philip B Gorelick - Department of Translational Neuroscience, Michigan State University College of Human Medicine, Grand Rapids (P.B.G.)Fady T Charbel - Department of Neurosurgery (S.A.-H., A.P.S., X.D., L.R.-F., F.T.C.), University of Illinois at ChicagoColin P Derdeyn - Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City (C.P.D.)
- Resource Type
- Journal article
- Publication Details
- Stroke (1970), Vol.51(11), pp.3295-3301
- Publisher
- United States
- DOI
- 10.1161/STROKEAHA.120.029909
- PMID
- 33032489
- PMCID
- PMC7606530
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Grant note
- R01 NS059745 / NINDS NIH HHS UL1 TR002003 / NCATS NIH HHS
- Language
- English
- Date published
- 11/2020
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984070338002771
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