Importance of variants in cerebrovascular anatomy for potential retrograde embolization in cryptogenic stroke
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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).
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.
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.
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.
• 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.
Keywords4D flow MRI Stroke Plaque Retrograde flow Circle of Willis
Compliance with ethical standards
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.
This study has received funding through NIH NHLBI grant R21 HL132357.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Written informed consent was waived by the Institutional Review Board.
• cross-sectional study
• performed at one institution
- 15.Frydrychowicz A, Francois CJ, Turski PA (2011) Four-dimensional phase contrast magnetic resonance angiography: potential clinical applications. Eur J RadiolGoogle Scholar
- 23.Bock J, Kreher B, Hennig J, Markl M. Optimized pre-processing of time-resolved 2D and 3D phase contrast MRI data. Proceedings of the 15th Annual Meeting of ISMRM, Berlin, Germany. 2007:3138.Google Scholar