基底动脉发育不良与后循环梗死的相关性

Association between basilar artery hypoplasia and posterior circulation infarction

目的：探讨基底动脉发育不良（ BAH）与后循环梗死的关系及其临床特点，以提高对BAH的认识。方法回顾性纳入2012年4月至2014年4月在中日友好医院神经内科住院期间行头颅MRA提示基底动脉走形正常、形态规则的住院患者328例，按照头颅MRA上基底动脉形态及直径分为BAH组（48例）与非BAH组（280例），通过临床分析及核磁影像对比两组一般资料、合并颅内血管变异，重点比较两组间后循环梗死的发生情况及梗死患者间基底动脉平均血流（ Vm），同时通过随访比较两组后循环梗死患者的临床转归，最后对BAH组中后循环梗死患者临床特征详述。结果（1）BAH组中合并椎动脉发育不良（VAH）24例（50．0％），胚胎型大脑后动脉（FTPA）18例（37．5％），永存三叉动脉1例（2．1％），椎动脉巨大开窗畸形1例（2．1％），经比较其较非BAH组更易合并颅内血管变异（ P＜0．05）；（2） BAH组后循环梗死发生率为35．4％（17／48），非BAH组为8．6％（24／280），经比较BAH组更易发生后循环缺血性卒中（P＜0．05），且BAH组后循环梗死患者基底动脉Vm明显低于非BAH组（ P＜0．05）；（3）两组后循环缺血性卒中患者在随访的4～28个月时间里均无死亡发生，非BAH组患者有3例再发后循环梗死。 BAH组出院时、出院后30 d、90 d mRS评分≤2分的改善率方面均优于非BAH组（均P＜0．05）；（4） BAH组卒中患者常表现为腔隙综合征（9／17），梗死部位以脑桥旁正中为著（9／17），且常合并双侧VAH＋单侧FTPA（8／17）。结论基底动脉发育不良并不少见，易合并其他颅内血管变异。可能由于其影响椎基底动脉系统血液供应，所以其后循环梗死者多于非BAH组，且以脑桥梗死常见。虽临床预后相对较好，我们尚需及早诊断，加强其卒中防治工作。

Objective To explore the relationship between basal artery hypoplasia （ BAH ） and posterior circulation ischemic stroke and its clinical characteristics to improve the understanding of BAH. Methods A total of 328 hospitalized patients from April 2012 to April 2014 were enrolled retrospectively. With normal course and regular shape of basilar artery on brain magnetic resonance angiography （ MRA） , other causes of posterior circulation ischemic stroke were excluded.They were divided into BAH （ n=48 ） and non-BAH （n=280） groups according to the morphology and diameter of basilar artery on head MRA. We compared the general information and intracranial vascular variations between two groups, especially the incidence rate of posterior circulation infarction and mean blood flow velocity （ Vm ） of basal artery by analyzing clinical information and MRI findings.Meantime, their clinical outcomes were observed through follow-ups.And detailed clinical features were discussed for the patients with posterior circulation infarction in the BAH group.Results （ 1 ） The concurrent lesions included vertebral artery intracranial segment hypoplasia （n=24, VAH）, fetal type posterior artery （n=18, FTPA）, persistent trigeminal artery （n=1） and giant fenestration variation on vertebral artery （ n=1 ） in the BAH group.In comparison, it was more liable to cranial vascular variations in the BAH group （ P＆lt;0.05 ） .（ 2 ） The incidence rates of posterior circulation infarction for two groups were 35.4% （ 17/48 ） and 8.6% （ 24/280 ） respectively. In comparison, these cases in the BAH group were more likely to suffer from posterior circulation ischemic stroke （P＆lt;0.05） and the Vm of basal artery in the BAH group was obviously lower than that in the non- 〈br〉 BAH group （ P＆lt;0.05）.（3） these cases with stroke in two groups had no mortality during a follow-up period of 4-28 months.There were 3 cases with recurrent posterior circulation stroke in the non-BAH group.The number of cases with mRS scoring 2 points or less in the BAH group was more than that in the non-BAH group at discharge, 30 or 90 days after discharge （ P＆lt;0.05 ） .（ 4 ） these cases with posterior circulation stroke in the BAH group often presented as lacunar syndrome （9/17）, paramedian infarction in pons （9/17） and bilateral VAH plus unilateral FTPA （8/17）.Conclusion As a relatively rare disease, BAH often has other intracranial vascular variants.Posterior circulation stroke occurs due to reduced blood supply of vertebrobasilar system, especially pons infarction.Though with relatively good clinical outcomes, we still need to make an early diagnosis and strengthen stroke prevention.