Arterial occlusions: does size matter?

Chuang et al investigated 191 patients with acute ischaemic stroke and found that 11.5% had a unilateral hypoplastic vertebral artery. 2 They found a significant relationship between vertebral artery hypoplasia and ipsilateral posterior circulation infarction. 2 In the New England Medical Center Posterior Circulation Registry, we also noted that in patients with infarcts involving the proximal intracranial territory fed by the vertebral arteries (medulla and posterior inferior cerebellum), occlusive lesions favoured the smaller vertebral artery ipsilateral to the infarcts. 3 These observations raise the larger question-among paired arteries, are the smaller arteries more likely to occlude? [...]I feel compelled to mention how often seeing single patients leads to observations and ideas that trigger investigations into basic principles.