椎动脉优势与后循环脑梗死复发的相关性

Correlation between vertebral artery dominance and recurrence of posterior circulation ischemic stroke

目的探讨椎动脉优势(VAD)与后循环脑梗死复发的相关性。方法对116例后循环脑梗死患者进行MRA检查,根据结果分为VAD组与非VAD组。比较两组椎动脉(VA)、基底动脉(BA)的收缩期血流速度(Vs)、搏动指数(PI)。随访12个月,比较两组后循环脑梗死复发率及梗死灶分布情况的差异。结果根据MRA检查结果,116例患者分为VAD组(72例),非VAD组(44例)。VAD组优势侧VA的Vs高于,PI低于非优势侧VA(均P<0.05);非VAD组双侧VA的Vs低于VAD组优势侧VA,但高于VAD组非优势侧VA(均P<0.05);非VAD组双侧VA的PI低于VAD组非优势侧VA(均P<0.05)。VAD组BA的PI高于非VAD组(P<0.05)。VAD组复发率(25.0%)明显高于非VAD组(9.1%)(χ2=4.498,P=0.034)。VAD组复发的脑梗死病灶在小脑后下动脉供血区域者7例,非VAD组则为0例,两组间差异有统计学意义(P<0.05)。结论存在VAD现象时,非优势侧VA的Vs下降,非优势侧VA及BA的PI值升高,后循环脑梗死复发率升高,且复发的脑梗死更易出现小脑下后动脉供血区。VAD现象可作为后循环脑梗死复发的预测指标。

Objective To explore the correlation between vertebral artery dominance （VAD） and recurrence of posterior circulation ischemic stroke （PCIS）. Methods One hundred and sixteen PCIS patients were detected by brain MRA. According to the results, patients were divided into VAD group and non-VAD group. The systolic velocity （Vs） and pulsatility index （PI） of vertebral artery （VA） and basilar artery （BA） were compared between two groups. Folllowed-up for 12 monthes, the recurrence rate of PCIS and the spatial distribution characteristics of recurrent PCIS infarction were compared between two groups. Results According to the results of the MRA, 116 patients were divided into VAD group （72 patients） and non-VAD group （44 patients）. In VAD group, the dominant VA showed significantly higher Vs but lower PI than those in non-dominant VA （ all P 〈 0. 05 ）. The level of Vs of bilateral VA in non-VAD group was sinificantly lower than that of the dominant VA in VAD group, but significantly higher than that of the non-dominant VA in VAD group （ all P 〈 0. 05 ）. The level of PI of bilateral VA in non-VAD group was lower than that of the non-dominant VA in VAD group （P 〈0. 05）. The level of PI of BA in VAD group was higher than that in non-VAD group （P 〈 0. 05 ）. The recurrence rate of PCIS in VAD group （25.0%） was significantly higher than that in non-VAD group （9.1% ） （X2 = 4. 498, P = 0. 034）. There were 7 cases of recurrent PCIS infarction in the posterior inferior cerebellar artery （PICA） territory in VAD group, and 0 case in non-VAD group. The difference between two groups was statistically significant （ P 〈 0. 05 ）. Conclusions In the presence of VAD, Vs of the non-dominant VA is lower, PI of the non-dominant VA and BA are higher, the recurrence rate of PCIS is increased, and recurrent PCIS infarction are often occurred in PICA territory. VAD can be used as a predictor on recurrence of posterior circulation ischemic stroke.