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• W2912284021 abstract "Reversal of flow in the vertebral artery is a common finding on cerebrovascular duplex ultrasound. The clinical significance and natural history of patients presenting with this finding, however, is poorly understood. A retrospective review was performed of all cerebrovascular duplex studies performed at our institution between January 2010 and January 2016. Individuals with reversal of flow in one or both vertebral arteries were included in the analysis. A total of 74 patients were thus included in our study. Half of all study patients were male. Mean age at the time of the first ultrasound demonstrating vertebral flow reversal was 71 years (range, 27-92 years). The demographics of the patients were as follows: 83% had hypertension, 57% had hyperlipidemia, 30% were diabetic, 70% were current/former smokers, 40% had PAD, 50% had CAD, and 21% had a history of TIA/CVA. Indications for the ultrasound were as follows: 44% screening/asymptomatic, 7% anterior circulation symptoms, 21% posterior circulation symptoms, 29% follow-up studies after cerebrovascular intervention, and 6% isolated upper extremity symptoms. At the time of the initial ultrasound, 21 patients (28%) had evidence of a prior unilateral/bilateral carotid intervention (CEA/CAS), 21 patients had evidence of moderate CAS (50%-79%) in at least one carotid artery, and 12 patients (16%) had evidence of severe CAS (>80%) in at least one carotid artery. The mean duration of follow-up was 28 ± 22 months. Follow-up data were available for 63 patients (85%), including the 15 patients who presented with posterior circulation symptoms. Of these 15 patients, five underwent PTA/stenting of the SCA with resolution of symptoms. Three patients were awaiting SCA stenting, including one patient who presented symptomatic after occlusion of a previously placed SCA stent. Three patients underwent CEA with resultant improvement in posterior circulation symptoms. Finally, two patients were lost to follow-up, one patient was deemed too high risk for intervention, and one patient was found to have an alternate etiology for symptoms. The remaining 59 patients continued to be asymptomatic during the follow-up period. One patient progressed to vertebral artery occlusion, and six patients had progression of their CAS during this interval. Symptomatic reversal of flow in the vertebral artery responds well to intervention, including SCA stenting and carotid intervention (CEA/CAS) in patients with anterior circulation symptoms. The majority of patients with this finding are asymptomatic at the time of presentation. Although progression of vertebral artery disease is rare, these patients should be monitored for progression of CAS with surveillance ultrasonography." @default.
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• W2912284021 date "2016-06-01" @default.
• W2912284021 modified "2023-09-30" @default.
• W2912284021 title "IP109. Clinical Significance of Reversal of Flow in the Vertebral Artery Identified on Cerebrovascular Duplex Ultrasound" @default.
• W2912284021 doi "https://doi.org/10.1016/j.jvs.2016.03.092" @default.
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