Abstract Body: Background and objectives: Vertebral artery hypoplasia (VAH) is a common anatomical variation. We aimed to investigate the association between VAH and atherosclerotic stenosis of subclavian artery (SA), vertebral artery (VA) and basilar artery (BA) based on digital subtraction angiography (DSA).
Methods: In this observational registry study, we reviewed patients from our comprehensive stroke center who underwent DSA from January 2013 to December 2023. Patients (age ≥ 18 years) with clinical manifestations of arterial disease or risk factors for atherosclerosis were included and classified into the VAH and non-VAH group. VAH and stenosis degree of the artery (i.e., SA, VA and BA) were determined by DSA. To investigate the association between VAH and the occurrence of above artery stenosis, a 1:2 ratio propensity score matching (PSM) and logistic regression analysis were performed. Additionally, we further conducted subgroup analysis.
Results: In present study, a total of 8,445 patients (mean [SD] age, 57.8 [14.4] years; 5,860 [69.4%] male and 2,585 [30.6%] female) were included. VAH was found in 1,683 of 8,445 patients (19.9%). After PSM, the presence of VAH was associated with frequency of contralateral subclavian artery stenosis (SAS) (left VAH: odd ratio [OR] 0.42, 95% confidence interval [CI] 0.25-0.68, p = 0.001; right VAH: OR 0.43, 95% CI 0.32-0.57, p < 0.001), contralateral vertebral artery stenosis (VAS) (left VAH: OR 1.84, 95% CI 1.52-2.23, p = 0.002; right VAH: OR 1.56, 95% CI 1.32-1.84, p < 0.001) and basilar artery stenosis (BAS) (left VAH: OR 2.94, 95% CI 2.15-4.04, p < 0.001; right VAH: OR 2.51, 95% CI 1.91-3.31, p < 0.001). In the subgroup analysis, the association remained significant (Figure 1).
Conclusion: VAH was associated with lower frequency of contralateral SAS and high frequency of contralateral VAS and BAS，highlighting the role of anatomical factors in the development of atherosclerotic lesions. VAH as an anatomical parameter, with its inherent associated hemodynamic consequences analyzed in future research, may be an important factor in predicting the risk of BAS, SAS and VAS contralateral to VAH.