Basilar Artery Lateral Displacement May Be Associated with Migraine with Aura

Background: Cerebrovascular dysregulation has long been associated with migraine pathophysiology, possibly mediated by hypoperfusion and/or endothelial dysfunction triggering cortical spreading depression. Vessel tortuosity has also been associated with altered hemodynamics and endothelial function. We sought to examine whether basilar artery (BA) tortuosity was altered in migraine. Methods: We performed the Anatomy and Cerebral Hemodynamic Evaluation of Migraine (ACHE-M) study, a prospective, observational, case-control study including high-resolution MR angiography, arterial spin labeled perfusion MRI, and structural MRI. Migraine with aura (MWA), migraine without aura (MwoA), and control subjects between the age of 25-50 were enrolled in a 1:1:1 ratio. Subjects with manifest vascular disease of any type were excluded. Vertebral and basilar artery diameters and BA total lateral displacement from MRI were correlated with regional perfusion and T2/FLAIR white matter lesions that were assessed using methods similar to the Cerebral Abnormalities in Migraine Epidemiologic Risk Analysis study. Results: 163 subjects were included (52 control/52 MWA/ 58 MwoA). Mean age was 33 ± 6 years, and 78% were female. BA diameter was similar across groups (3.6 ± 0.6 mm in all 3 groups). BA displacement was similar in MwoA (5.1±3.0 mm) and controls (4.9±3.1 mm), but tended to be greater in MWA (6.3±3.8 mm, p=0.055 vs. controls). In multivariate analysis incorporating migraine status, age, and sex, BA displacement was significantly associated with MWA (p=0.019), age (p<0.001), and sex (p=0.046). BA displacement was also significantly greater with increasing migraine frequency (p=0.003). There was no association with displacement and posterior cerebral artery territory cerebral blood flow or overall white matter lesion burden. Conclusions: Basilar artery lateral displacement is associated with MWA as well as headache frequency, but this association does not appear to be mediated by cerebral hypoperfusion. Further investigation of the physiological consequences of basilar artery lateral displacement may lead to new insights into the mechanisms of migraine.

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Basilar artery curvature is associated with migraine with aura in the Northern Manhattan Study

Journal of the Neurological Sciences ◽

10.1016/j.jns.2021.120073 ◽

2021 ◽

pp. 120073

Author(s):

Dixon Yang ◽

Cen Zhang ◽

Setareh S. Omran ◽

Brett Cucchiara ◽

Tatjana Rundek ◽

...

Keyword(s):

Migraine With Aura ◽

Basilar Artery

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Abstract WP542: Basilar Artery Curvature is Associated With Migraine With Aura in the Northern Manhattan Study

Stroke ◽

10.1161/str.50.suppl_1.wp542 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Cen Zhang ◽

Brett Cucchiara ◽

Alperin Noam ◽

Ahmet Bagci ◽

Tatjana Rundek ◽

...

Keyword(s):

Migraine With Aura ◽

Basilar Artery

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Abstract P374: Dolichoectacic Features of Basilar Artery Serve an Imaging Surrogate of Branch Artery Disease in Patients With Pontine Infarcts

Stroke ◽

10.1161/str.52.suppl_1.p374 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Dogan Dinc Oge ◽

Ethem M Arsava ◽

Mehmet A Topcuoglu

Keyword(s):

Basilar Artery ◽

Lateral Displacement ◽

Surrogate Marker ◽

Artery Occlusion ◽

Imaging Studies ◽

Lateral Deviation ◽

Ischemic Lesion ◽

Resolution Imaging ◽

Imaging Markers ◽

Artery Disease

Background: The arterial pathology underlying recent small subcortical infarctions (historically known as lacunar stroke) is heterogenous and includes lipohyalinosis, branch artery atherosclerosis or embolism. Although the use of high-resolution imaging studies directed to vessel wall might be helpful in teasing out these different pathologies, more readily available imaging surrogates such as size or spatial characteristics of the ischemic lesion are used for this purpose in clinical practice. Herein, we determined the distribution of dolichoectacic features of basilar artery in patients presenting with pontine penetrator artery stroke with different underlying occlusive pathologies. Methods: The dolichoectacic features of basilar artery were retrospectively evaluated according to Smoker’s criteria (diameter: >4.5 mm, laterality: more lateral to the lateral margin of clivus or dorsum sellae, and height of bifurcation: at least at the level of third ventricular floor) on CT angiography in ischemic stroke patients with a single penetrator artery occlusion in the pons. Patients with basilar artery pathologies such stenosis, dissection, or apparent dolichoectasia were excluded. Ischemic lesions extending to the surface of pontine base on DWI were judged to be secondary to branch artery occlusion, rather than lipohyalinosis. Results: Out of 122 patients, 68 (56%) had at least one feature suggestive of basilar artery dolichoectasia. Patients with lateral deviation of basilar artery were more likely to harbor infarcts extending to pontine surface (69% vs. 50%); no such relationship was identified for other imaging markers of dolichoectasia. After adjustment for age, gender and vascular risk factors, lateral deviation of the basilar artery remained significantly associated with an infarct pattern suggestive of branch artery occlusion (OR=2.8, 95%CI 1.1-7.3; p=0.031). There was also a tendency for ischemic lesions to be located on the ipsilateral side of the lateral deviation (63%; p=0.081). Conclusion: Our findings highlight that lateral displacement of basilar artery, an imaging feature of basilar dolichoectasia, can be used as an additional surrogate marker of branch artery pathology in patients with pontine penetrator artery infarction.

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