Anatomical Variations of the Vertebral Arteries, and their Impact on Cerebral Circulation

Background: the vertebral arteries are integral to the vertebrobasilar system, contributing approximately 20%
of cerebral blood flow and ensuring perfusion of the posterior brain and spinal cord. Anatomical variations such as
hypoplasia and dolichoectasia may compromise posterior circulation hemodynamics and influence cerebrovascular risk.
Objective: to investigate the prevalence, diameter, and gender distribution of vertebral artery variations and assess their
potential clinical implications for posterior cerebral circulation.
Materials and Methods: A retrospective observational study was conducted on 60 patients (25 females, 41.7%; 35
males, 58.3%; mean age 45.0 ± 12.0 years). Radiological evaluation included Magnetic Resonance Angiography, Doppler
ultrasonography, and Computed Tomography. Vertebral artery morphology was classified as normal, hypoplastic, or
dolichoectatic.
Results: Hypoplasia was the most frequent variation. In females, hypoplasia was observed in 28.0% of left and 40.0%
of right vertebral arteries. In males, it was present in 20.0% of left and 22.9% of right arteries. Dolichoectasia was
more prevalent in males. These findings highlight gender-related differences and underscore the importance of vascular
imaging in patients with posterior circulation symptoms.
Conclusion: Vertebral artery variations are relatively common and clinically significant. Recognition of these variations
is essential for accurate diagnosis, risk stratification, and management of cerebrovascular disorders involving posterior
circulation.