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Importance of variants in cerebrovascular anatomy for potential retrograde embolization in cryptogenic stroke

  • Magnetic Resonance
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Abstract

Objectives

To test the hypothesis that variants in cerebrovascular anatomy will affect the number of patients demonstrating a plausible retrograde embolization mechanism from plaques in the descending aorta (DAo).

Methods

Thirty-five patients (aged 63 ± 17 years) with cryptogenic stroke underwent 4D flow MRI for the assessment of aortic 3D blood flow and MR angiography for the evaluation of circle of Willis, posterior circulation, and aortic arch architecture. In patients with proven DAo plaque, retrograde embolization was considered a potential mechanism if retrograde flow extended from the DAo to a supra-aortic vessel supplying the cerebral infarct territory.

Results

Retrograde embolization with matching cerebral infarct territory was detected in six (17%) patients. Circle of Willis and aortic arch variant anatomy was found in 60% of patients, leading to reclassification of retrograde embolization risk as present in three (9%) additional patients, for a total 26% of cryptogenic stroke patients.

Conclusion

4D flow MRI demonstrated 26% concordance with infarct location on imaging with retrograde diastolic flow into the feeding vessels of the affected cerebral area, identifying a potential etiology for cryptogenic stroke. Our findings further demonstrate the importance of cerebrovascular anatomy when determining concordance of retrograde flow pathways with vascular stroke territory from DAo plaques.

Key points

• Retrograde embolization from descending aortic plaques constitutes a plausible etiology in cryptogenic stroke.

• Common variants of cerebrovascular anatomy are important in determining retrograde embolization mechanism.

• Variant cerebrovascular anatomy can link retrograde flow pathways with vascular stroke territory.

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Authors and Affiliations

  1. Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Michael Markl, Edouard Semaan, James Carr & Jeremy Collins

  2. Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA

    Michael Markl

  3. Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    LeRoy Stromberg & Shyam Prabhakaran

  4. Department of Radiology, Edward Hospital, Naperville, IL, USA

    LeRoy Stromberg

Authors
  1. Michael Markl
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  2. Edouard Semaan
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  3. LeRoy Stromberg
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  4. James Carr
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  5. Shyam Prabhakaran
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  6. Jeremy Collins
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Corresponding author

Correspondence to Michael Markl.

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Guarantor

The scientific guarantor of this publication is Michael Markl.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

This study has received funding through NIH NHLBI grant R21 HL132357.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Written informed consent was waived by the Institutional Review Board.

Methodology

• retrospective

• cross-sectional study

• performed at one institution

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Markl, M., Semaan, E., Stromberg, L. et al. Importance of variants in cerebrovascular anatomy for potential retrograde embolization in cryptogenic stroke. Eur Radiol 27, 4145–4152 (2017). https://doi.org/10.1007/s00330-017-4821-0

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  • DOI: https://doi.org/10.1007/s00330-017-4821-0

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