Background
Carotid duplex ultrasonography (CUS) has been used to identify reversed vertebral
artery flow (RVAF) at the extracranial cervical artery in some patients with subclavian
steal syndrome. However, the characteristics of intracranial RVAF as evaluated by
transcranial color flow imaging (TC-CFI), which can examine intracranial hemodynamics
in a real-time and noninvasive fashion, remain unclear. The goal of this study was
to analyze the prevalence of intracranial RVAF and its associated clinical characteristics.
Methods
Subjects were consecutive patients who underwent TC-CFI and CUS. We evaluated blood
flow in both intracranial vertebral arteries (VAs) from the suboccipital echo window
using TC-CFI. RVAF was defined as a flow signal directed toward the probe. We calculated
the prevalence of intracranial RVAF in our subjects. Then, we investigated vascular
condition (ie, site of lesion, stenosis, occlusion, and dissection) using magnetic
resonance angiography, computed tomography angiography , and CUS in patients with
intracranial RVAF.
Results
Seven hundred twenty patients (508 men; median age, 73 years) were included in this
study from September 2007 to March 2013. Intracranial RVAF was seen in 12 patients
(1.7%; 11 men; median age, 61 years). Among the 12 patients with intracranial RVAF,
8 patients (67%) had ischemia of the vertebrobasilar territory with distal VA occlusion,
according to CUS. Of those patients, 6 (75%) had dissection of the VA.
Conclusions
TC-CFI detected intracranial RVAF in 1.7% of consecutive examinations in our facility.
In vertebrobasilar territory stroke patients with intracranial RVAF, VA dissection
may contribute to the development of stroke.
Key Words
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Article info
Publication history
Published online: June 03, 2015
Accepted:
March 31,
2015
Received in revised form:
March 3,
2015
Received:
October 28,
2014
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.03.044
Copyright
© 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
