Download PDF
J Neurol Surg A Cent Eur Neurosurg 2019; 80(05): 365-370
DOI: 10.1055/s-0038-1677453
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Association between Vertebral Artery Hypoplasia and Vertebral Artery Aneurysms: A Case-Control Study

Ali Harati
1   Department of Neurosurgery, Klinikum Dortmund, Dortmund, Nordrhein-Westfalen, Germany
,
Dominik Zeh
1   Department of Neurosurgery, Klinikum Dortmund, Dortmund, Nordrhein-Westfalen, Germany
,
Stefan Rohde
2   Department of Neuroradiology, Klinikum Dortmund, Dortmund, Nordrhein-Westfalen, Germany
,
Rolf Schultheiß
1   Department of Neurosurgery, Klinikum Dortmund, Dortmund, Nordrhein-Westfalen, Germany
,
Kirsten Schmieder
3   Department of Neurosurgery, Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
,
Juha Hernesniemi
4   Department of Neurosurgery, Juha Hernesniemi International Center, Henan Province People's Hospital, Zhengzhou, China
› Author Affiliations
Further Information

Publication History

17 June 2018

05 September 2018

Publication Date:
04 July 2019 (online)

   Permissions and Reprints

Abstract

Background The aim of this retrospective case-control study was to determine the association of vertebral artery hypoplasia (VAH) and other anatomical variants with saccular vertebral artery posterior inferior cerebellar artery (VA-PICA) aneurysms.

Methods The frequency of VAH, vertebral artery (VA) atresia, VA aplasia, and PICA aplasia was analyzed using computed tomography (CT) angiography in 64 patients with VA-PICA aneurysms (43 ruptured and 21 unruptured) and compared with 128 age- and sex-matched controls. Logistic regression was performed to identify independent risk factors for aneurysm formation.

Results Univariate analysis showed that patients with VA-PICA aneurysms had a significantly higher frequency of VAH (53% versus 17%; odds ratio [OR] 4.8; 95% confidence interval [CI], 2.4–9.4; p < 0.0001) and VA aplasia (14% versus 1%; OR 20.8; 95% CI, 2.5–168.0; p = 0.004) compared with controls. VA-PICA aneurysms are detected significantly more often in the dominant VA, which is contralateral to VAH. Other anatomical variants are not related to aneurysm formation.

Conclusions VAH and VA aplasia are potential risk factors for VA-PICA aneurysms. Altered hemodynamics caused by VAH may result in intracranial aneurysm formation. Additional research should clarify the pathophysiologic association of VAH, VA aplasia, or vascular occlusion with arteriosclerosis and intracranial aneurysm formation.

Keywords

computed tomography angiography - intracranial aneurysm - posterior inferior cerebellar artery - vertebral artery - vertebral artery hypoplasia - posterior circulation
 

  • References

  • 1 Lister JR, Rhoton Jr AL, Matsushima T, Peace DA. Microsurgical anatomy of the posterior inferior cerebellar artery. Neurosurgery 1982; 10 (02) 170-199
    CrossrefPubMedGoogle Scholar
  • 2 George B, Bruneau M, Spetzler M. , eds. Pathology and Surgery Around the Vertebral Artery. Paris, France: Springer Science and Business Media; 2011
    Google Scholar
  • 3 Gaigalaite V, Vilimas A, Ozeraitiene V. , et al. Association between vertebral artery hypoplasia and posterior circulation stroke. BMC Neurol 2016; 16: 118
    CrossrefPubMedGoogle Scholar
  • 4 Perren F, Poglia D, Landis T, Sztajzel R. Vertebral artery hypoplasia: a predisposing factor for posterior circulation stroke?. Neurology 2007; 68 (01) 65-67
    CrossrefPubMedGoogle Scholar
  • 5 Zhou M, Zheng H, Gong S. , et al. Vertebral artery hypoplasia and vertebral artery dissection: a hospital-based cohort study. Neurology 2015; 84 (08) 818-824
    CrossrefPubMedGoogle Scholar
  • 6 Thierfelder KM, Baumann AB, Sommer WH. , et al. Vertebral artery hypoplasia: frequency and effect on cerebellar blood flow characteristics. Stroke 2014; 45 (05) 1363-1368
    CrossrefPubMedGoogle Scholar
  • 7 Lehto H, Kivisaari R, Niemelä M. , et al. Seventy aneurysms of the posterior inferior cerebellar artery: anatomical features and value of computed tomography angiography in microneurosurgery. World Neurosurg 2014; 82 (06) 1106-1112
    CrossrefPubMedGoogle Scholar
  • 8 Mitsumura H, Miyagawa S, Komatsu T, Hirai T, Kono Y, Iguchi Y. Relationship between vertebral artery hypoplasia and posterior circulation ischemia. J Stroke Cerebrovasc Dis 2016; 25 (02) 266-269
    CrossrefPubMedGoogle Scholar
  • 9 Park J-H, Kim J-M, Roh J-K. Hypoplastic vertebral artery: frequency and associations with ischaemic stroke territory. J Neurol Neurosurg Psychiatry 2007; 78 (09) 954-958
    CrossrefPubMedGoogle Scholar
  • 10 Hu X-Y, Li Z-X, Liu H-Q. , et al. Relationship between vertebral artery hypoplasia and posterior circulation stroke in Chinese patients. Neuroradiology 2013; 55 (03) 291-295
    CrossrefPubMedGoogle Scholar
  • 11 Chuang Y-M, Chan L, Wu H-M, Lee S-P, Chu Y-T. The clinical relevance of vertebral artery hypoplasia. Acta Neurol Taiwan 2012; 21 (01) 1-7
    PubMedGoogle Scholar
  • 12 Zhang DP, Lu GF, Zhang JW, Zhang SL, Ma QK, Yin S. Vertebral artery hypoplasia and posterior circulation infarction in patients with isolated vertigo with stroke risk factors. J Stroke Cerebrovasc Dis 2017; 26 (02) 295-300
    CrossrefPubMedGoogle Scholar
  • 13 Zhang DP, Ma QK, Zhang JW, Zhang SL, Lu GF, Yin S. Vertebral artery hypoplasia, posterior circulation infarction and relative hypoperfusion detected by perfusion magnetic resonance imaging semiquantitatively. J Neurol Sci 2016; 368: 41-46
    CrossrefPubMedGoogle Scholar
  • 14 Katsanos AH, Kosmidou M, Giannopoulos S. Vertebral artery hypoplasia in posterior circulation cerebral ischemia. Clin Neurol Neurosurg 2013; 115 (07) 1194-1195
    CrossrefPubMedGoogle Scholar
  • 15 Jeng J-S, Yip P-K. Evaluation of vertebral artery hypoplasia and asymmetry by color-coded duplex ultrasonography. Ultrasound Med Biol 2004; 30 (05) 605-609
    CrossrefPubMedGoogle Scholar
  • 16 Matula C, Trattnig S, Tschabitscher M, Day JD, Koos WT. The course of the prevertebral segment of the vertebral artery: anatomy and clinical significance. Surg Neurol 1997; 48 (02) 125-131
    CrossrefPubMedGoogle Scholar
  • 17 Ogeng'o J, Olabu B, Sinkeet R, Ogeng'o NM, Elbusaid H. Vertebral artery hypoplasia in a black Kenyan population. Int Sch Res Notices 2014; 2014: 934510
    PubMedGoogle Scholar
  • 18 Nemati M, Bavil AS, Taheri N. Comparison of normal values of Duplex indices of vertebral arteries in young and elderly adults. Cardiovasc Ultrasound 2009; 7 (01) 2
    CrossrefPubMedGoogle Scholar
  • 19 Hong JM, Chung C-S, Bang OY, Yong SW, Joo IS, Huh K. Vertebral artery dominance contributes to basilar artery curvature and peri-vertebrobasilar junctional infarcts. J Neurol Neurosurg Psychiatry 2009; 80 (10) 1087-1092
    CrossrefPubMedGoogle Scholar
  • 20 Liu I-W, Ho B-L, Chen C-F. , et al. Vertebral artery terminating in posterior inferior cerebellar artery: a normal variation with clinical significance. PLoS One 2017; 12 (04) e0175264
    CrossrefPubMedGoogle Scholar
  • 21 Choudhary P, Khokhar HV, Saxena S. Giant serpentine vertebrobasilar aneurysm with vertebral artery hypoplasia and fenestration—a case report. J Clin Diagn Res 2015; 9 (03) TD01-TD02
    PubMedGoogle Scholar
  • 22 Lehto H, Harati A, Niemelä M. , et al. Distal posterior inferior cerebellar artery aneurysms: clinical features and outcome of 80 patients. World Neurosurg 2014; 82 (05) 702-713
    CrossrefPubMedGoogle Scholar
  • 23 Peluso JPP, van Rooij WJ, Sluzewski M, Beute GN. Distal aneurysms of cerebellar arteries: incidence, clinical presentation, and outcome of endovascular parent vessel occlusion. AJNR Am J Neuroradiol 2007; 28 (08) 1573-1578
    CrossrefPubMedGoogle Scholar
  • 24 Orakcioglu B, Schuknecht B, Otani N, Khan N, Imhof HG, Yonekawa Y. Distal posterior inferior cerebellar artery aneurysms: clinical characteristics and surgical management. Acta Neurochir (Wien) 2005; 147 (11) 1131-1139 ; discussion 1139
    CrossrefPubMedGoogle Scholar
  • 25 Al-khayat H, Al-Khayat H, Beshay J, Manner D, White J. Vertebral artery-posteroinferior cerebellar artery aneurysms: clinical and lower cranial nerve outcomes in 52 patients. Neurosurgery 2005; 56 (01) 2-10 ; discussion 11
    PubMedGoogle Scholar
  • 26 Hashimoto N, Handa H, Nagata I, Hazama F. Animal model of cerebral aneurysms: pathology and pathogenesis of induced cerebral aneurysms in rats. Neurol Res 1984; 6 (1–2): 33-40
    CrossrefPubMedGoogle Scholar
  • 27 Hashimoto N, Handa H, Nagata I, Hazama F. Experimentally induced cerebral aneurysms in rats: Part V. Relation of hemodynamics in the circle of Willis to formation of aneurysms. Surg Neurol 1980; 13 (01) 41-45
    PubMedGoogle Scholar
  • 28 Kaspera W, Ładziński P, Larysz P. , et al. Morphological, hemodynamic, and clinical independent risk factors for anterior communicating artery aneurysms. Stroke 2014; 45 (10) 2906-2911
    CrossrefPubMedGoogle Scholar
  • 29 Jabbarli R, Reinhard M, Roelz R. , et al. Clinical relevance of anterior cerebral artery asymmetry in aneurysmal subarachnoid hemorrhage. J Neurosurg 2017; 127 (05) 1070-1076
    CrossrefPubMedGoogle Scholar