Research Of Relationship Between Vertebral Artery Hypoplasia And PCI

Objective：With the progress of society and the improvement of livingstandard, the pattern of disease is changing and the morbidity and mortality ofstroke is also increasing. Stroke is an important risk factor for death anddisability in middle aged and elderly people and causes great damage to healthand affects the social and economic development seriously. It was reportedthat the survival rate of stroke patients in one month, one year and five yearswas respectively83%,71%and46%. Savitz et al pointed out that ischemiccerebral stroke accounted for80%of stroke and posterior circulation ischemia(PCI) accounted for about20%of all ischemic cerebral stroke. Posteriorcirculation is composed of vertebral arteries, basilar artery, posterior cerebralartery and its branches which supply blood for very important and complexstructures such as brain stem, cerebellum, thalamus, occipital lobe, theposterior temporal lobe and the upper spinal cord. Compared to anteriorcirculation infarction, PCI had more complex condition and higher mortalityrate, which caused serious results to mankind. In recent years, with thewidespread application of neuroimaging, ultrasound and neural interventionaltechnology, vertebral artery hypoplasia in PCI has gradually been takenseriously. With the development of magnetic resonance imaging, especiallythe gradient magnetic field technology, scanning speed was becoming faster,and a new method of magnetic resonance angiography, namelythree-dimensional contrast-enhanced magnetic resonance angiography (3D CEMRA) emerged. It has wide applicability and strong practicability, and canshow cervical vascular more clearly than ordinary magnetic resonanceangiography. Our research compared the different distribution of vertebralartery hypoplasia in anterior circulation infarction and PCI through mesuringthe diameter of V2of the vertebral artery using3D CE MRA to explore the influence and pathological significance of vertebral artery hypoplasia to PCI.Methods：A total of97patients (64men,33women), aged65.91±11.68years (ranging from25to90years) who were admitted in neurologydepartment of our hospital in March2012to July2013for ischemic cerebralstroke within1week of clinical onset, were selected in the research and allmet the diagnostic criteria of Fourth National Cerebrovascular DiseaseConference. Patients were classified according to the location of stroke asanterior circulation group (control group) and posterior circulation group. Allpatients had CT examination to rule out cerebral hemorrhage andsubarachnoid hemorrhage. We collected cerebrovascular disease risk factors.Brain magnetic resonance imaging, diffusion weighted imaging (DWI) andcervical3D CE MRA were performed on all patients by the SiemensTim-avanto1.5T superconductance magnetic resonance within3days ofadmission if there is no prohibition. According to Fisher’s diagnostic criteria,vertebral artery hypoplasia was defined as diameter below2mm and slender orinvisible. To make it reliable, the MRA of each patient was reviewed by twoinvestigators. Our research compared the distribution of vertebral arteryhypoplasia in anterior circulation group (control group) and posteriorcirculation group through examining the diameter of V2of the vertebral arteryusing3D CE MRA to explore the influence and pathological significance ofvertebral artery hypoplasia to PCI. The data was analyzed with SPSS16.0statistic software, measurement data meeting normal distribution used the ttest and meeting non-normal distribution use non-parament test, enumerationdata used chi square test.Results:1General information: There were68cases (70.10%) in anteriorcirculation group and29cases (29.90%) in posterior circulation group of thetotel97patients with ischemic cerebral stroke. There were no significantdifferences in cerebro-vascular disease risk factors (age, gender, hypertension,diabetes mellitus, hyperlipemia, hyperhomocysteinemia, coronary heartdisease, smoke, drinking) between the two groups (P>0.05). 2Vertebral artery hypoplasia: In the total of97patients with ischemiccerebral stroke, vertebral artery hypoplasia was present in22patients(22.68%). There were15cases (68.18%) with right-sided vertebral arteryhypoplasia, compared to7cases (31.82%) with left-sided vertebral arteryhypoplasia. None of the patients had bilateral vertebral artery hypoplasia.Vertebral artery hypoplasia occurred in14cases of the men and8cases of thewomen.3Vertebral artery hypoplasia in two groups: Vertebral artery hypoplasiawas diagnosed in17cases (58.62%) of posterior circulation group (29cases)compared to only5cases (7.35%) of anterior circulation group (68cases).This difference was significant (P <0.001).4Vertebral artery hypoplasia and PCI: There were2transient ischemicattack (TIA) patients and27posterior circulation infarction patients inposterior circulation group (29cases). Two patients with TIA both showedright-sided vertebral artery hypoplasia. There were9cases with right-sidedvertebral artery hypoplasia, compared to6cases with left-sided vertebralartery hypoplasia of27posterior circulation infarction patients.Conclusions:1Vertebral artery hypoplasia is one of a very important risk factor forPCI. When people have vertebral artery hypoplasia, they should pay moreattention to risk factor such as hypertension, diabetes mellitus, hyperlipemia,smoke and drinking in order to reduce the morbidity of PCI.2Unilateral vertebral artery hypoplasia is relatively common andright-side is more than left-side. Bilateral vertebral artery hypoplasia isrelatively rare.3Patients with vertebral artery hypoplasia, gender has no obviousdifference.4Noninvasive examination of cervical3D CE MRA can identifyvertebral artery hypoplasia early, so it can provide objective bases for earlyprevention and treatment of PCI.