Are Strokes Mostly Genetically Based or Acquired? Stenosis vs Hypoplasia of Vertebral Artery Anomalous as The Leading Cause of Stroke (Anatomical Study of VA Anomalies in Neck Three-Dimensional Computed Tomography Angiography)

Background: A thorough understanding of the vertebral artery (VA) variations and course of the artery and its related branches could significantly enhance the efficacy and safety of interventions involving the neck and spine. Here, we aimed to investigate the incidence of various VA variations in individuals presenting with signs and symptoms of stroke with our neurology team. In this cross-sectional study, all patients referred to our specialized medical imaging center and underwent neck CT-angiography (CTA) were enrolled in this study for two years from September 2019 onward. Patients' information forms were obtained to collect demographic data. Results An experienced board-certified radiologist evaluated the CTA images, recording the characteristics of VA, regarding dominance and any possible anomalies. These included anomalous origin, anomalous route, anomalous branching, stenosis, hypoplasia, atresia, thrombosis, and dissection. A total of 125 patients (53.6% females; mean age, 60.7 (11–87)) were included. In the case of VA dominance, 66.4% of cases were co-dominant while 16.0% were right, and 12.8% were left dominant. Overall, males had more VA anomalies than females, 24.8% and 17.6%, respectively (in general, 42.4% of all participants) (p = 0.020). Among patients, 4.0% (n = 5) had an anomalous origin and anomalous branching was reported in 5 patients (4.0%). Among the variations, significant stenosis (18.4%) and hypoplasia (17.6%) were the most prevalent anomalies with the earliest one having the higher rate. While anomalous branching was reported in 5 patients (4.0%). Conclusions VA variations are relatively common and should be addressed during procedures involving the neck region and would allow surgeons to avoid life threatening injury.