Imaging of vertebral artery stenosis: a systematic review

Khan, S.; Cloud, G. C.; Kerry, S.; Markus, H. S.
November 2007
Journal of Neurology, Neurosurgery & Psychiatry;Nov2007, Vol. 78 Issue 11, p1218
Academic Journal
Background and purpose: Posterior circulation stroke accounts for 20% of ischaemic strokes. Recent data suggest that the early stroke recurrence risk is high and comparable with carotid artery disease. Vertebral artery stenosis accounts for approximately 20% of posterior circulation stroke, and with endovascular treatment available accurate diagnostic imaging is important. We performed a systematic literature review to validate the accuracy of the non-invasive imaging techniques Duplex ultrasound (DUS), magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) in detecting severe vertebral artery stenosis, with intra-arterial angiography (IAA) as the reference standard. Methods: We identified studies that used non-invasive imaging and IAA as the reference standard to determine vertebral artery stenosis and provided adequate data to calculate sensitivity and specificity. We analysed the quality of these studies, looked for evidence of heterogeneity and performed subgroup analysis for different degrees of stenosis. Results: 11 studies categorised stenosis into 50-99%. The sensitivity of CIA (single study) and pooled sensitivities of contrast enhanced MRA (CE-MRA) and colour duplex were 100% (95% CI 15.8 to 100), 93.9% (79.8 to 99.3) and 70.2% (54.2 to 83.3), respectively. The specificities for CIA, CE-MRA and colour duplex were 95.2% (83.8 to 99.4), 94.8% (91 .1 to 97.3) and 97.7% (95.2 to 99.1). However, specificities for CE-MRA and colour duplex demonstrated significant heterogeneity (p=0.003 and p=0.002, respectively). Conclusions: CE-MRA and possibly CIA may be more sensitive in diagnosing vertebral artery stenosis than DUS. However, data are limited and further high quality studies comparing DUS, MRA and CIA with IAA are required.


Related Articles

  • Risk Factors and Clinical Outcomes of Childhood Ischemic Stroke in a Single Korean Tertiary Care Center. Lee, Eun Hye; Yum, Mi-Sun; Ko, Tae-Sung // Journal of Child Neurology;Apr2012, Vol. 27 Issue 4, p485 

    A 10-year, retrospective review of the risk factors and clinical outcome of childhood ischemic stroke treated in a single tertiary care center was conducted. Sixty-two children were identified (33 boys and 29 girls), ages 1 month to 17 years. Risk factors included vasculopathy (35.5%), cardiac...

  • Serum Levels of the MCP-1 Chemokine in Patients With Ischemic Stroke and Myocardial Infarction. Arakelyan, A.; Petrkova, J.; Hermanova, Z.; Boyajyan, A.; Lukl, J.; Petrek, M. // Mediators of Inflammation;8/14/2005, Vol. 2005 Issue 3, p175 

    Chemokine driven migration of inflammatory cells has been implicated in pathogenesis of atherosclerosis-associated conditions such as ischemic stroke and myocardial infarction. In this study, a candidate chemokine, monocyte chemoattractant protein (MCP)-1, was investigated in patients with both...

  • Can cardiovascular risk factors and lifestyle explain the educational inequalities in mortality from ischaemic heart disease and from other heart diseases? Strand, Bjørn Heine; Tverdal, Aage // Journal of Epidemiology & Community Health;Aug2004, Vol. 58 Issue 8, p705 

    Despite a distinct decline in ischaemic heart disease (IHD) mortality in the late 1980s, IHD is still the commonest cause of death in both Norwegian men and women. An inverse relation between IHD and socioeconomic status (SES) in industrialized western societies has been reported for middle aged...

  • Arterial Ischemic Stroke in Childhood: Risk Factors and Outcome in Old Versus New Era. G�kben, Sarenur; Tosun, Ayse; Bayram, Nun; Serdaroglu, Gul; Polat, Muzaffer; Kavakli, Kaan; Tekgul, Hasan // Journal of Child Neurology;Oct2007, Vol. 22 Issue 10, p1204 

    Risk factors of children with arterial ischemic stroke were retrospectively evaluated. The children were grouped according to values on developing diagnostic tools: 13 in the old era (1987- 1994) and 18 in the new era (1995-2004), The old era battery included 5 tests: protein C, protein S,...

  • Towards assessment of the mechanisms related to myocardial infarction in young individuals. Chrysohoou, C.; Stefanadis, C. // Journal of Postgraduate Medicine;Oct2009, Vol. 55 Issue 4, p314 

    In this article the author discusses the mechanisms related to myocardial infarction in young individuals. He is critical on the cause of mortality among young patients with acute myocardial infarction (AMI) which is characterized by evidence of multiple cardiovascular risk factors and delayed...

  • EXERTIONAL NUMBNESS AS A UNIQUE FEATURE IN INTERMITTENT CLAUDICATION. Lennihan, Richard; Mackereth, Martha // Angiology;Oct1973, Vol. 24 Issue 9, p563 

    Some patients with intermittent claudication develop exertional numbness involving the skin of the toes and foot. This may be a valuable clue to more dangerous ischemia, or it may be harmless. The problem call be clarified using ankle blood pressure as determined with the Doppler ultrasound flow...

  • MAN OF 81 YEARS OLD WITH SUBACUTE INSTALLED PARAPARESIS. Ioan, Buraga // Romanian Journal of Neurology;2011, Vol. 10 Issue 3, p141 

    Total medullar syndrome section has multiple causes including the most common are trauma with or without bone involvement, spinal tumors, myelitis and ischemia. At various stages of clinical presentation are written plus some features of each etiology in part. Differential diagnosis often...

  • Adenosine-mediated cardioprotection in the aging myocardium. Willems, Laura; Ashton, Kevin J.; Headrick, John P. // Cardiovascular Research;May2005, Vol. 66 Issue 2, p245 

    Abstract: With aging, it appears the heart''s ability to withstand injury declines markedly. Unfortunately, the incidence of ischemic disorders increases dramatically with age. Though the genesis of the ischemia-intolerant phenotype is incompletely understood (and likely multi-factorial), it may...

  • Application of Framingham risk estimates to ethnic minorities in United Kingdom and implications for primary prevention of heart disease in general practice: cross sectional population based study. Cappuccio; Oakeshott, Pippa; Strazzullo, Pasquale; Kerry, Sally M. // BMJ: British Medical Journal (International Edition);11/30/2002, Vol. 325 Issue 7375, p1271 

    Objective: To compare the 10 year risk of coronary heart disease (CHD), stroke, and combined cardiovascular disease (CVD) estimated from the Framingham equations. Design: Population based cross sectional survey. Setting Nine general practices in south London. Population 1386 men and women, age...


Read the Article


Sign out of this library

Other Topics