SE Neurológiai és Pszichiátriai Klinika közös tanterme
2022-05-09 13:00:00
Cardiovascular Disorders: Physiology and Medicine of Ischaemic Circulatory Diseases
Dr. Merkely Béla
Dr. Tárnoki Ádám Domonkos
Dr. Győri Dávid Sándor
Dr. Horváth Andrea
Dr. Bereczki Dániel
Dr. Dósa Edit
Dr. Vastagh Ildikó
The vertebrobasilar system is unique in anatomical terms, as it is the only instance in the human body where a third artery is formed by the merging of two arteries. Asymmetrical vertebral artery (VA) flow and diameter are common findings, and the vertebral system is often left dominant. Unequal VA flow may lead to complex secondary blood flow patterns in the basilar artery (BA), which may cause bending of the artery over time. Increased VA diameter difference, tortuosity and torsion and increased BA curvature and tortuosity may cause oscillating and low wall shear stress, which plays an important role in the pathogenesis of atherosclerosis. These changes over time may lead to vertebrobasilar insufficiency. Increased white matter hyperintensity (WHM) burden has been considered as an indicator for inadequate blood perfusion on T2 weighted Fluid-attenuated inversion recovery images. The presence of WMH triples the risk of stroke and doubles the risk of dementia. Previous publications showed significant correlation between vertebrobasilar artery morphology and stroke localization. However, the connection between WMHs and large cerebral artery morphology is not yet fully understood. Furthermore, the genetic and environmental determinants influencing the development of the vertebrobasilar morphological indices are not yet clear.
We created a standardized and semi-automated technique to recreate and to measure the morphology of the vertebrobasilar system. We demonstrated that VA dominance influences the morphological indices of the BA. These changes correlate with WMH localization and burden. Increased bending direction of the BA with increased infratentorial lateral WMH burden may be a signal for inadequate blood flow in conjunction with chronic ischemia. We used the classical twin model and revealed that most of the VA and BA morphology were influenced by shared and unshared factors which highlights the complex hemodynamical background of the vertebrobasilar system. BA length and volume showed moderate genetic influence.
