椎动脉发育不良患者对侧椎动脉和基底动脉病变的特点

Characteristic of contralateral vertebral artery and basilar artery vascular lesion in patients with vertebral artery hypoplasia

目的探讨椎动脉发育不良(VAH)患者对侧椎动脉和基底动脉病变的特点。方法连续入组我院2014年12月至2018年2月首次发作且有完整的颅内外超声血管评估的急性脑梗死患者。采用超声筛查VAH(V2段<2.5mm)及血管狭窄并经头颈部CTA、MRA或DSA确认,且排除椎动脉夹层对VAH诊断的干扰。比较在前循环和后循环梗死中VAH的发生率。在后循环梗死患者中,分析存在VAH的患者对侧椎动脉、基底动脉、Willis环的情况。结果共入组750例患者,男性436例(58%),女性314例(42%);年龄18~90岁,平均65岁。后循环梗死193例(25.7%),前循环梗死557例(74.3%),在后循环梗死中检出VAH的比率高(33.7%VS14.1%,P<0.01)。吸烟是VAH合并后循环梗死的独立危险因素(OR=2.767,95%CI:1.45~5.08,P<0.05)。VAH并后循环梗死患者的基底动脉狭窄(OR=2.07,95%CI:1.00~4.26,P<0.05)、对侧椎动脉狭窄(OR=3.22,95%CI:1.24~8.37,P<0.05)、以及胚胎型大脑后动脉(OR=2.17,95%CI:1.00~4.68,P<0.05)的发生率明显高于非VAH组。结论后循环梗死患者中VAH的发生率高;VAH合并后循环梗死患者对侧椎动脉狭窄和基底动脉狭窄的频率较高。

Objective To investigate the characteristic of contralateral vertebral artery and basilar artery vascular lesion in patients of vertebral artery hypoplasia ( VAH).Methods All first-episode acute cerebral infarction patients with complete extra-intracranial ultrasound evaluation from December 2014 to February 2018 were recruited consecutively.Ultrasound was used to screen VAH ( V2 segment < 2.5 mm) and stenosis and confirmed by head and neck CTA,MRA or DSA,and the interference of vertebral artery dissection on VAH diagnosis was excluded.The incidence of VAH between the anterior and posterior circulation infarctions was compared.In patients with posterior circulation infarction,the contralateral vertebral artery,basilar artery,and Willis ring were analyzed from patients with VAH.Results The study included 750 patients,436 males ( 58%),314 females ( 42%),mean age 65 years,age range 18 - 90 years.There had 193 ( 25.7%) patients with a posterior circulation infarction,557 ( 74.3%) with an anterior circulation infarction.VAH was more often detected in the posterior circulation infarction group ( 33.7% VS.14.1 %;P < 0. 0001 ).Smoking was an independent risk factor for posterior circulation infarction with VAH ( OR = 2.767,95%CI: 1.45 - 5.08,P < 0. 05).Patients with posterior circulation infarction and VAH had a significantly higher frequency of basilar artery stenosis ( OR = 2.07,95% CI: 1.00 - 4.26;P < 0. 05),stenosis of the contralateral vertebral artery ( OR = 3.22,95% CI: 1.24 - 8.37;P < 0. 05),and fetal type variant of the posterior cerebral artery ( OR = 2.17,95%CI: 1.00 - 4.68;P < 0.05).Conclusion VAH identifies patients at higher risk of posterior circulation infarction,and higher frequency of contralateral vertebral artery stenosis and basilar artery stenosis.