PCI患者基底动脉迂曲方向与其优势椎动脉的关系研究

Analysis of the relationship between tortuous direction of basilar artery and its dominant vertebral artery in patients with posterior circulation cerebral ischemia based on magnetic resonance sequence examination

目的探讨后循环脑缺血(posterior circulation ischemia,PCI)患者基底动脉迂曲方向与其优势椎动脉的关系。方法回顾性选取高安市人民医院2019年1月至2022年4月神经内科收治的脑梗死/短暂性脑缺血发作(transient ischemic attack,TIA)患者142例,均给予MR血管成像检查,并根据检查结果分为椎动脉优势(vertebral artery dominance,VAD)组(n=80)、非VAD组(n=62);根据牛津郡社区脑卒中项目分型标准分为前循环组(n=64)、后循环组(n=78),其中伴VAD的前循环患者25例,伴VAD的后循环患者55例。分析影响VAD患者合并前循环组基底动脉弯曲的相关因素及基底动脉迂曲与VAD的关系,并就相关典型病例进行说明。结果VAD合并前循环组基底动脉弯曲的患者比例低于VAD合并后循环组(P<0.05);多因素非条件Logistic回归结果显示,基底动脉弯曲为影响VAD患者合并后循环缺血的危险因素(OR=2.273,P<0.05);经Pearson相关系数分析,VAD与基底动脉迂曲相关(r=0.854,P<0.001),且基底动脉迂曲方向与VAD呈相反方向。结论基底动脉弯曲为影响VAD患者合并后循环缺血的危险因素,VAD与基底动脉迂曲相关,且基底动脉迂曲方向与VAD呈相反方向。

Objective To investigate the relationship between tortuous direction of basilar artery and its dominant vertebral artery in patients with posterior circulation ischemia(PCI).Methods A total of 142 patients with cerebral infarction/transient ischemic attack(TIA)admitted to the Department of Neurology in Gao’an People’s Hospital from January 2019 to April 2022 were retrospectively selected,all patients were given MR angiography(MRA)examination after admission,and were divided into vertebral artery dominance(VAD)group(80 cases)and non-VAD group(62 cases)according to the examination results.According to the Oxfordshire Community Stroke Project classification criteria,they were divided into anterior circulation group(64 cases)and posterior circulation group(78 cases),including 25 patients with VAD in anterior circulation and 55 patients with posterior circulation with VAD.To analyze the related factors affecting the curvature of basilar artery in VAD patients with anterior circulation group and the relationship between basilar artery tortuosity and VAD,and to explain the related typical cases.Results The proportion of patients with basilar artery curvature in VAD combined with anterior circulation group was lower than that in VAD combined with posterior circulation group(P<0.05);Multivariate unconditional Logistic regression results showed that basilar artery curvature was a risk factor affecting VAD patients with posterior circulation ischemia(OR=2.273,P<0.05).According to Pearson correlation coefficient analysis,VAD was correlated with basilar artery tortuosity(r=0.854,P<0.001),and the direction of basilar artery tortuosity was opposite to that of VAD.Conclusion The basilar artery tortuosity is a risk factor affecting the posterior circulation ischemia in VAD patients.VAD is associated with basilar artery tortuosity,and the basilar artery tortuosity is in the opposite direction to VAD.