Frequency and Predictors of Ultrasound-Detected Extracranial Vertebral Artery Stenosis in a Sample of Non-Western Population

Abstract

Objective

Extracranial vertebral artery (VA) stenosis represents an important aetiology of ischaemic vascular events in the posterior circulation. Nevertheless, it remains insufficiently investigated. Ethnic differences might be related to VA stenosis. In this regard, Egyptian studies are scarce. We aimed to investigate the frequency and predictors of extracranial VA stenosis in a sample of Egyptian patients.

Methods

We enrolled consecutive patients who were referred to our neurovascular ultrasonography laboratory for routine clinical indications. Extracranial VA stenosis was diagnosed and graded using ultrasound.

Results

We included 528 patients in our study. Significant extracranial VA stenosis ≥ 50% was found among 10.4% (n = 10/96) of patients with ischaemic vascular events in the posterior circulation and 4.2% (n = 18/432) of patients without (p = 0.01). One patient received stenting for VA origin stenosis. Carotid atherosclerosis was present in 82.1% (n = 23/28) of patients with significant extracranial VA stenosis in comparison with 47.6% (n = 238/500) of those without (p < 0.001). In an age- and sex-adjusted multivariate binary logistic regression, the following factors predicted significant extracranial VA stenosis: age > 60 years (OR 2.68, 95% CI 1.08–6.66, p = 0.03), significant common/internal carotid artery (CCA/ICA) stenosis ≥ 50% (OR 4.81, 95% CI 1.89–12.29, p = 0.001) and ischaemic vascular events in the posterior circulation (OR 2.78, 95% CI 1.17–6.65, p = 0.02).

Conclusions

The frequency of extracranial VA stenosis seems to be lower among Egyptians in comparison with Western cohorts. Among patients with carotid atherosclerosis or significant CCA/ICA stenosis and/or ischaemic vascular events in the posterior circulation, meticulous ultrasound examination of the VA is warranted to detect possibly underlying extracranial VA stenosis.