In severe intracranial vertebral artery stenosis, systemic inflammation (hs-CRP) was associated with higher odds of posterior circulation infarction, with vertebral artery volume flow partly mediating this association, supporting a potential 'inflammatory-hemodynamic interaction' characterized by a 'low-flow, high-inflammation' phenotype.
Each 1-mg/L increase in hs-CRP was independently associated with significantly higher odds of posterior circulation infarction in patients with severe intracranial vertebral artery stenosis.
The association between hs-CRP and posterior circulation infarction was nonlinear, with a threshold effect and a plateau at higher concentrations.
Network analysis identified hs-CRP as a central node within the biomarker network among patients with severe intracranial vertebral artery stenosis.
Vertebral artery volume flow (VAVF) partially mediated the association between hs-CRP and posterior circulation infarction.
The association between hs-CRP and posterior circulation infarction was strongest in patients with the lowest vertebral artery volume flow.
The study was a retrospective cohort of 253 consecutive patients with newly diagnosed severe intracranial vertebral artery stenosis, of whom 37.9% developed posterior circulation infarction during follow-up.
This research suggests that in patients with severe narrowing of the vertebral arteries in the brain, higher levels of a blood marker of inflammation (hs-CRP) are associated with a substantially increased risk of stroke in the posterior (back) part of the brain. The researchers found that for every 1 mg/L increase in hs-CRP, the odds of experiencing a posterior circulation stroke increased by about 26%. Notably, this relationship was not perfectly linear — the risk increased steeply up to a certain hs-CRP level (about 5.67 mg/L) and then appeared to plateau at very high levels (above about 13.28 mg/L). The study also found that reduced blood flow through the vertebral arteries appeared to partly explain — or 'mediate' — the link between inflammation and stroke risk, accounting for about 13% of the association. Additionally, patients who had both low blood flow and high inflammation appeared to be at the greatest risk, which the researchers describe as a 'low-flow, high-inflammation' phenotype. Network analysis further highlighted hs-CRP as a central, highly connected factor among the biological markers studied. This research suggests that systemic inflammation and impaired local blood flow may work together, rather than independently, to promote strokes in patients with severe intracranial artery narrowing. If confirmed in future prospective studies, this 'inflammatory-hemodynamic' framework could potentially help identify higher-risk patients and inform whether targeting inflammation might reduce stroke risk in this population.
Yuan X, Zhang Y, Ma W, Ren Y, Shao J. (2026). Inflammatory-hemodynamic interplay in severe intracranial stenosis: hs-CRP, vertebral artery flow, and posterior circulation infarction.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1829231