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Background <p>Isolated pontine infarction (IPI) is closely linked to the hemodynamic properties of the vertebral artery. However, the underlying pathogenic mechanisms remain insufficiently defined. This study was designed to explore the contribution of vertebral artery hemodynamic disturbances to the development of IPI and identify the optimal hemodynamic cut-off values for predicting IPI risk in patients with vertebral artery dominance (VAD).</p> Materials and methods <p>A total of 381 individuals were enrolled. These included 205 patients with acute IPI and 176 control individuals without cerebrovascular disease who were hospitalized during the same period. Computed tomography angiography (CTA) and magnetic resonance imaging (MRI) were used to determine infarct location and evaluate the diameter and curvature of the vertebral arteries and basilar artery (BA). Hemodynamic parameters of the vertebral arteries were measured using color Doppler flow imaging (CDFI). Receiver operating characteristic (ROC) curves were used to identify the optimal cut-off values of dominant-side hemodynamic parameters for predicting IPI risk in patients with VAD. Appropriate statistical analyses were used for intergroup comparisons and correlation assessments.</p> Results <p>A total of 321 (84.25%) of the 381 enrolled subjects were diagnosed with VAD. Among these, patients with IPI had a significantly lower dominant-side end-diastolic velocity (EDV, 22.72 ± 7.29&#xa0;cm/s) compared with controls. In contrast, the dominant-side resistance index (RI, 0.61 ± 0.07), pulsatility index (PI, 1.06 ± 0.21), and the peak systolic velocity/end-diastolic velocity ratio (PSV/EDV, 2.70 ± 0.61) were all significantly elevated. Subgroup analysis revealed that patients with paramedian pontine infarction showed similarly pronounced differences in dominant-side EDV (22.64 ± 7.26&#xa0;cm/s), RI (0.62 ± 0.07), PI (1.07 ± 0.23), and PSV/EDV (2.75 ± 0.69) relative to the controls. Among the 192 patients with both VAD and BA curvature, 130 (67.7%) demonstrated BA curvature contralateral to the dominant vertebral artery (Spearman rank correlation, <i>r</i> = − 0.296, <i>P</i> &lt; 0.0001). Control subjects with BA curvature showed no significant dominant-side hemodynamic abnormalities compared with VAD control subjects without BA curvature (<i>P</i> &gt; 0.05). ROC curve analysis identified the optimal cut-off values for key dominant-side hemodynamic parameters: EDV ≤ 20.50&#xa0;cm/s, RI ≥ 0.57, PI ≥ 0.93 and PSV/EDV ≥ 2.35.</p> Conclusion <p>These findings indicate a strong association between VAD and acute IPI, mediated by significant disturbances in vertebral artery hemodynamics. A reduced EDV, accompanied by increased RI, PI, and PSV/EDV, was observed consistently, with the most marked alterations occurring in the paramedian infarction subtype. BA curvature does not represent an independent risk factor for IPI, but is merely a morphological mediator that exacerbates VAD-related hemodynamic disturbances. The identification of cut-off values of dominant-side hemodynamic parameters provides a foundation for the early identification of hemodynamic risk, thereby enabling targeted interventions for VAD-related IPI.</p>

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Hemodynamic disturbances in vertebral artery dominance: a potential pathogenic mechanism in acute isolated pontine infarction

  • 期刊论文

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  • 发表日期：

    2026年4月6日

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  • Yanquan Yuan,
  • Shan Wei,
  • Shijie Xu,
  • Jiaohao Li,
  • Yao Zeng,
  • Yutian Zhang,
  • Yuxin Wang,
  • Zhiyong Huang,
  • Xiaolong Lin,
  • Chun Xiao,
  • You Li,
  • Linfa Chen

摘要

Background

Isolated pontine infarction (IPI) is closely linked to the hemodynamic properties of the vertebral artery. However, the underlying pathogenic mechanisms remain insufficiently defined. This study was designed to explore the contribution of vertebral artery hemodynamic disturbances to the development of IPI and identify the optimal hemodynamic cut-off values for predicting IPI risk in patients with vertebral artery dominance (VAD).

Materials and methods

A total of 381 individuals were enrolled. These included 205 patients with acute IPI and 176 control individuals without cerebrovascular disease who were hospitalized during the same period. Computed tomography angiography (CTA) and magnetic resonance imaging (MRI) were used to determine infarct location and evaluate the diameter and curvature of the vertebral arteries and basilar artery (BA). Hemodynamic parameters of the vertebral arteries were measured using color Doppler flow imaging (CDFI). Receiver operating characteristic (ROC) curves were used to identify the optimal cut-off values of dominant-side hemodynamic parameters for predicting IPI risk in patients with VAD. Appropriate statistical analyses were used for intergroup comparisons and correlation assessments.

Results

A total of 321 (84.25%) of the 381 enrolled subjects were diagnosed with VAD. Among these, patients with IPI had a significantly lower dominant-side end-diastolic velocity (EDV, 22.72 ± 7.29 cm/s) compared with controls. In contrast, the dominant-side resistance index (RI, 0.61 ± 0.07), pulsatility index (PI, 1.06 ± 0.21), and the peak systolic velocity/end-diastolic velocity ratio (PSV/EDV, 2.70 ± 0.61) were all significantly elevated. Subgroup analysis revealed that patients with paramedian pontine infarction showed similarly pronounced differences in dominant-side EDV (22.64 ± 7.26 cm/s), RI (0.62 ± 0.07), PI (1.07 ± 0.23), and PSV/EDV (2.75 ± 0.69) relative to the controls. Among the 192 patients with both VAD and BA curvature, 130 (67.7%) demonstrated BA curvature contralateral to the dominant vertebral artery (Spearman rank correlation, r = − 0.296, P < 0.0001). Control subjects with BA curvature showed no significant dominant-side hemodynamic abnormalities compared with VAD control subjects without BA curvature (P > 0.05). ROC curve analysis identified the optimal cut-off values for key dominant-side hemodynamic parameters: EDV ≤ 20.50 cm/s, RI ≥ 0.57, PI ≥ 0.93 and PSV/EDV ≥ 2.35.

Conclusion

These findings indicate a strong association between VAD and acute IPI, mediated by significant disturbances in vertebral artery hemodynamics. A reduced EDV, accompanied by increased RI, PI, and PSV/EDV, was observed consistently, with the most marked alterations occurring in the paramedian infarction subtype. BA curvature does not represent an independent risk factor for IPI, but is merely a morphological mediator that exacerbates VAD-related hemodynamic disturbances. The identification of cut-off values of dominant-side hemodynamic parameters provides a foundation for the early identification of hemodynamic risk, thereby enabling targeted interventions for VAD-related IPI.