Anatomical Variations of the Vertebral Arteries, and their Impact on Cerebral Circulation
AJTES Vol 10, No. 2, July 2026
Zylbeari G. et al. - Vertebral Artery Variations and Cerebral Circulation.

Keywords

Vertebral artery
anatomical variations
hypoplasia
dolichoectasia
posterior cerebral circulation

How to Cite

Zylbeari, G., Bexheti, Z., Cakalaroski, K., Bexheti, S., & Krstev, T. (2026). Anatomical Variations of the Vertebral Arteries, and their Impact on Cerebral Circulation. Albanian Journal of Trauma and Emergency Surgery, 10(2), 2093-2096. https://doi.org/10.32391/ajtes.v10i2.545

Abstract

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.

https://doi.org/10.32391/ajtes.v10i2.545
Zylbeari G. et al. - Vertebral Artery Variations and Cerebral Circulation.

References

Gray’s Anatomy, 39th Edition: The Anatomical Basis of Clinical Practice. (2005). AJNR: American Journal of Neuroradiology, 26(10), 2703–2704.

Campero, A., Rubino, P.A., Rhoton, A.L. (2011). Anatomy of the vertebral artery. In: Pathology and surgery around the vertebral artery. Springer, Paris. https://doi.org/10.1007/978-2-287-89787-0_4

Caplan L. (2000). Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000. Stroke, 31(8), 2011–2023. https://doi.org/10.1161/01.str.31.8.2011

Savitz, S. I., & Caplan, L. R. (2005). Vertebrobasilar disease. The New England journal of medicine, 352(25), 2618–2626. https://doi.org/10.1056/NEJMra041544

Lippincott Williams & Wilkins, Philadelphia, PA: 1999. (1999). Osborn AG, Diagnostic Cerebral Angiography. AJNR: American Journal of Neuroradiology, 20(9), 1767–1769.

Satti, S. R., Cerniglia, C. A., & Koenigsberg, R. A. (2007). Cervical vertebral artery variations: an anatomic study. AJNR. American journal of neuroradiology, 28(5), 976–980.Hong JT, et al. Anatomical variations of vertebral artery. J Korean Neurosurg Soc. 2009.

Park JH, Kim JM, Roh JK, Hypoplastic vertebral artery: frequency and associations with ischaemic stroke territory, J Neurol Neurosurg Psychiatry, 2007, 78(9):954–958.

El Otmani, H., Fotso, V., El Moutawakil, B., & Rafai, M. A. (2020). Basilar artery fenestration and ischemic stroke: An unclear causal relationship. Journal de medecine vasculaire, 45(2), 62–66. https://doi.org/10.1016/j.jdmv.2020.01.147

Hirano, Y., Miyawaki, S., Yamada, K., Shinya, Y., Kin, T., Amemiya, S., Asakawa, Y., Nakatomi, H., & Saito, N. (2020). Vascular anomaly of the posterior circulation associated with intracranial lipoma-like lesion in the cerebral peduncle manifesting as oculomotor nerve palsy. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 72, 463–466. https://doi.org/10.1016/j.jocn.2019.12.020

Katsanos, A. H., Kosmidou, M., Kyritsis, A. P., & Giannopoulos, S. (2013). Is vertebral artery hypoplasia a predisposing factor for posterior circulation cerebral ischemic events? A comprehensive review. European neurology, 70(1-2), 78–83. https://doi.org/10.1159/000351786

Piccinin MA, Munakomi S. Neuroanatomy, Vertebrobasilar System. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK540995/

Caplan L. R. (1981). Vertebrobasilar disease. Time for a new strategy. Stroke, 12(1), 111–114. https://doi.org/10.1161/01.str.12.1.111

Doss, A., & Phatouros, C. C. (2006). Vertebrobasilar insufficiency. Current treatment options in cardiovascular medicine, 8(2), 111–119. https://doi.org/10.1007/s11936-006-0003-0

Rhoton AL. The cerebral arteries. Neurosurgery. 2002. van der Grond J, et al. Circle of Willis collateral flow. Stroke. 2004.

Valenzuela-Fuenzalida J, et al. Vertebral artery hypoplasia: prevalence and clinical significance in cerebrovascular disease. J Neuroimaging. 2024.

Park JH, et al. Vertebral artery hypoplasia and its association with posterior circulation ischemia. AJNR Am J Neuroradiol. 2007;28(8):1530–1534.

Katsanos AH, et al. Vertebral artery hypoplasia and posterior circulation stroke: a systematic review. J Neurol Sci. 2017; 375:139–144.

Bruneau, M., Cornelius, J. F., Marneffe, V., Triffaux, M., & George, B. (2006). Anatomical variations of the V2 segment of the vertebral artery. Neurosurgery, 59(1 Suppl 1), ONS20–ONS24. https://doi.org/10.1227/01.NEU.0000219931.64378.B5

Copyright (c) 2026 Gazmend Zylbeari, Zamira Bexheti, Koco Cakalaroski, Sadi Bexheti, Tose Krstev