后循环梗死与椎基底动脉狭窄的相关性分析

Study of correlation between posterior circulation infarction and vertebrobasilar artery stenosis

目的探讨MRI所示的后循环梗死灶与DSA发现的椎基底动脉狭窄的相关性。方法回顾分析30例后循环梗死患者的临床资料,将每例后循环梗死患者头部MRI发现的梗死灶与DSA所见的椎基底动脉狭窄血管进行对照。结果 MRI示单发性梗死22例(其中脑干梗死10例,小脑梗死8例,丘脑梗死2例,枕叶梗死2例),多发性梗死8例。DSA发现大动脉狭窄19例[包括单纯椎动脉近段(V1)狭窄、椎动脉V1段狭窄伴颅内段狭窄、椎动脉颅内段狭窄、基底动脉狭窄及锁骨下动脉狭窄],与之对应的MRI发现的梗死部位位于小脑下后动脉(PICA)供血区、小脑下前动脉(AICA)供血区、小脑上动脉(SCA)供血区及大脑后动脉(PCA)供血区,以小脑下后动脉(PICA)供血区多见。分支动脉狭窄9例,与之对应的MRI发现的梗死部位位于PICA、AICA、SCA及PCA供血区。2例DSA椎基底动脉未见明显异常,头部MRI见PICA和AICA供血区有多发性小梗死灶。结论后循环梗死的MRI表现与椎基底动脉狭窄性病变部位具有相关性。大动脉狭窄的病例中,椎动脉V1段狭窄最常见,其梗死部位多位于PICA供血区。通过MRI检查,早期明确后循环梗死的部位和范围,可能推测导致梗死的病变血管。

Objective To investigate the correlation between the site of posterior circulation infarction and vertebrobasilar artery stenosis.Methods Clinical data of 30 patients with posterior circulation infarction were analyzed retrospectively.The sites of posterior circulation infarction detected by magnetic resonance imaging（MRI） were compared with the vascular lesions in vertebrobasilar arteries detected by digital subtraction angiography（DSA）.Results Twenty-two patients with single cerebral infarction detected by MRI（brainstem infarction 10 patients,cerebellar infarction 8 patients,thalamic infarction 2 patients,occipital lobe infarction 2 patients）.Eight patients with multiple cerebral infarction detected by MRI.DSA found that 19 patients had large arterial stenosis,including proximal vertebral artery（V1） stenosis,V1 segmental stenosis complicated with intracranial artery stenosis,intracranial vertebral artery stenosis,basilar artery stenosis and subclavian artery stenosis.The infarct sites were the territories of posterior inferior cerebellar artery（PICA）,anterior inferior cerebellar artery（AICA）,superior cerebellar artery（SCA）,posterior cerebral artery（PCA） by MRI,most of them were the territories of posterior inferior cerebellar artery.Nine patients had branch artery stenosis,the infarct sites were the territories of PICA,AICA,SCA,and PCA by MRI.DSA did not show any obvious abnormality in 2 patients in the vertebrobasilar arteries,bus MRI revealed multiple small infarcts in the territories of PICA and AICA.Conclusion Posterior circulation infarction is correlated with their stenotic responsible arteries.Early identifying the locations and types of posterior circulation infarction by MRI scan may predict the responsible vessels of posterior circulation infarction.