Optimized Hemodynamic Assessment to Predict Stroke Risk in Vertebrobasilar Disease: Analysis From the VERiTAS Study. Issue 12 (16th June 2020)

• Record Type: Journal Article
• Authors: See, Alfred P.; Pandey, Dilip K.; Du, Xinjian; Rose‐Finnell, Linda; Charbel, Fady T.; Derdeyn, Colin P.; Amin‐Hanjani, Sepideh
• Other Names: Richardson DeJuran investigator.; Xie Hui investigator.; Thulborn Keith investigator.; Flanner Michael P. investigator.; Ganin Hagai investigator.; Ruland Sean investigator.; Grysiewicz Rebecca investigator.; Khaja Aslam investigator.; Pedelty Laura investigator.; Testai Fernando investigator.; Ong Archie investigator.; Epstein Noam investigator.; Muqtadar Hurmina investigator.; Watson Karriem investigator.; Mlinarevich Nada investigator.; Hillmann Maureen investigator.; Elkind Mitchell S. V. investigator.; Hirsch Joy investigator.; Dashnaw Stephen investigator.; Meyers Philip M. investigator.; Willey Josh Z. investigator.; McNeill‐Simaan Edwina investigator.; Perez Veronica investigator.; Canaan Alberto investigator.; Paulino‐Hernandez Wayna investigator.; Zipfel Gregory J. investigator.; Vo Katie investigator.; Foster Glenn investigator.; Ford Andria investigator.; Nassief Abdullah investigator.; Bradley Abbie investigator.; Serna‐Northway Jannie investigator.; Kraus Kristi investigator.; Shiwani Lina investigator.; Hantler Nancy investigator.; Liebeskind David S. investigator.; Alger Jeffrey investigator.; Godinez Sergio investigator.; Saver Jeffrey L. investigator.; Ali Latisha investigator.; Kim Doojin investigator.; Tenser Matthew investigator.; Froehler Michael investigator.; Raychev Radoslav investigator.; Song Sarah investigator.; Ovbiagele Bruce investigator.; Abcede Hermelinda investigator.; Adamczyk Peter investigator.; Rao Neal investigator.; Yallapragada Anil investigator.; Modir Royya investigator.; Hinman Jason investigator.; Tansy Aaron investigator.; Calderon‐Arnulphi Mateo investigator.; Sheth Sunil investigator.; Noorian Alireza investigator.; Ng Kwan investigator.; Liang Conrad investigator.; Gadhia Jignesh investigator.; Smith Hannah investigator.; Avila Gilda investigator.; Avelar Johanna investigator.; Silver Frank L. investigator.; Mikulis David investigator.; Fierstra Jorn investigator.; Hlasny Eugen investigator.; Casaubon Leanne K. investigator.; Vergouwen Mervyn investigator.; Martin del Campo J. C. investigator.; Jaigobin Cheryl S. investigator.; Astorga Cherissa investigator.; Kalman Libby investigator.; Kramer Jeffrey investigator.; Vaughan Susan investigator.; Owens Laura investigator.; Richardson DeJuran investigator.; Thulborn Keith R. investigator.; Caplan Louis R. investigator.; Gorelick Philip B. investigator.; Kasner Scott E. investigator.; Kissela Brett investigator.; Turan Tanya N. investigator.; Aletich Victor investigator.; Jacobs Tom P. investigator.; Janis Scott investigator.;
• Is Part Of: Journal of the American Heart Association. Volume 9:Issue 12(2020)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-06-16
• Subjects: blood flow -- magnetic resonance angiography -- magnetic resonance imaging -- quantitative magnetic resonance angiography -- stroke vertebrobasilar disease; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.120.016406
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : Background: Atherosclerotic vertebrobasilar disease is a significant etiology of posterior circulation stroke. The prospective observational VERiTAS (Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke) study demonstrated that distal hemodynamic status is a robust predictor of subsequent vertebrobasilar stroke risk. We sought to compare predictive models using thresholds for posterior circulation vessel flows standardized to age and vascular anatomy to optimize risk prediction. Methods and Results: VERiTAS enrolled patients with recent vertebrobasilar transient ischemic attack or stroke and ≥50% atherosclerotic stenosis/occlusion in vertebral and/or basilar arteries. Quantitative magnetic resonance angiography measured large‐vessel vertebrobasilar territory flow, and patients were designated as low or normal flow based on a prespecified empiric algorithm considering distal territory regional flow and collateral capacity. For the present study, post hoc analysis was performed to generate additional predictive models using age‐specific normalized flow measurements. Sensitivity, specificity, and time‐to‐event analyses were compared between the algorithms. The original prespecified algorithm had 50% sensitivity and 79% specificity for future stroke risk prediction; using a predictive model based on age‐normalized flows in the basilar and posterior cerebral arteries, standardized to vascular anatomy, optimized flow status thresholds were identified. The optimized algorithm maintained sensitivity and increased specificity to 84%, while demonstrating a larger and more significant hazard ratio for stroke on time‐to‐event analysis. Conclusions: These results indicate that flow remains a strong predictor of stroke across different predictive models, and suggest that prediction of future stroke risk can be optimized by use of vascular anatomy and age‐specific normalized flows.