Use of quantitative magnetic resonance angiography to stratify stroke risk in symptomatic vertebrobasilar disease
Sepideh Amin-Hanjani1, Xinjian Du, Meide Zhao
1Department of Neurosurgery, University of Illinois at Chicago, 912 S Wood St, Chicago, IL 60612-7329, USA. hanjani@uic.edu
Insights
Quantitative hemodynamic assessment using QMRA can identify patients with symptomatic vertebrobasilar disease (VBD) at high risk for recurrent stroke. Low distal flow indicates a need for intervention, while normal flow suggests medical therapy alone is sufficient.
Area of Science:
- Neurology
- Vascular Medicine
- Medical Imaging
Background:
- Symptomatic vertebrobasilar disease (VBD) is associated with a significant risk of recurrent stroke.
- Effective risk stratification and management strategies are crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate a management algorithm utilizing quantitative hemodynamic assessment to stratify stroke risk in symptomatic VBD patients.
- To determine if this assessment could guide the need for intervention.
Main Methods:
- A protocol involving quantitative magnetic resonance angiography (QMRA) was used to assess patients with symptomatic VBD.
- Patients were stratified based on the presence or absence of distal flow compromise.
- Outcomes were reviewed for patients managed with this protocol between 1998 and 2003.
Main Results:
- Patients with low distal flow (n=16) had significantly higher rates of recurrent stroke/TIA compared to those with normal flow (n=31) (P=0.003).
- Two-year event-free survival was 71% for low flow and 100% for normal flow.
- Intervention in low-flow patients improved event-free survival to 82%.
Conclusions:
- Low distal flow on QMRA identifies symptomatic VBD patients at high risk for stroke.
- Normal distal flow suggests a benign course, potentially managed with medical therapy alone.
- Quantitative hemodynamic assessment can effectively guide intervention decisions in VBD.
Background And Purpose:
Symptomatic vertebrobasilar disease (VBD) carries a high risk of recurrent stroke. We sought to determine whether a management algorithm consisting of quantitative hemodynamic assessment could stratify stroke risk and guide the need for intervention.
Methods:
All patients with symptomatic VBD at our institution are evaluated by a standard protocol including quantitative magnetic resonance angiography (QMRA). Patients are stratified on the basis of the presence or absence of distal flow compromise. Those with low distal flow are offered intervention (surgical or endovascular); all patients receive standard medical therapy. We reviewed the clinical outcome of patients managed with this protocol from 1998 to 2003.
Results:
Follow-up was available for 47 of 50 patients over a mean interval of 28 months. Stroke and combined stroke/transient ischemic attack free survival at 2 years was calculated using the Kaplan-Meier curve. Patients with normal distal flow (n=31) had an event-free survival of 100% and 96%, respectively. Comparatively, patients with low distal flow (n=16) experienced a 71% and 53% event-free survival, demonstrating a significantly higher risk of recurrent ischemia (P=0.003). Patients with low flow who subsequently underwent treatment (n=12) had an 82% event-free survival. Cox proportional hazards analysis demonstrated that flow status affected event-free survival regardless of covariates.
Conclusions:
Patients with symptomatic VBD demonstrating low distal flow on QMRA appear to have a high risk of stroke; conversely, those with normal flow seem to have a benign course and may be optimally managed with medical therapy alone.
