A Clinical Study On Vertebral Artery Dominance In Patients With Posterior Circulation Ischemic Stroke

Objective: Analyze the relationship between vertebral artery dominance(VAD)and posterior circulation ischemic stroke(PCIS),between VAD and other risk factors,between VAD and infarction in various regions of the posterior circulation,between the side of VAD and the side of infarction.To explore the clinical significance of vertebral artery dominance in the occurrence and development of posterior circulation ischemic stroke.METHODS: Collect the general data of ischemic stroke patients and patients hospitalized in the Neurology Department of the Second Hospital of Jilin University from November 2019 to November 2020,including gender,age,personal history,past history,laboratory data,and imaging data.According to sphagitides color doppler ultrasound(SCDU),to determine whether patients are accompanied by VAD,they are divided into VAD group and non-VAD group,and the differences in the above-mentioned clinical data between the two groups are compared;The results of magnetic resonance imaging(MRI)and diffusion welghted imaging(DWI)determine the location of the patient’s cerebral infarction,which is divided into anterior circulation ischemic stroke group(ACIS),posterior circulation ischemic stroke group(PCIS)and anterior and posterior circulation ischemic stroke mixed group,compare the differences in the above-mentioned clinical data and vertebral artery dominance between the three groups;according to the different blood supply areas of the posterior circulation cerebral infarction,the posterior circulation cerebral infarction Divided into PICA area,BA area,PCA area and SCA area,compare the difference in vertebral artery dominance between the four different blood supply areas,and analyze the relationship between the infarcted side and the dominated side of the vertebral artery.Use Excel to input and sort data,and use SPSS24.0 software to analyze the data.Results: A total of 444 patients with acute ischemic stroke were enrolled.There were330 cases(74.32%)in the VAD group and 114 cases(25.68%)in the non-VAD group.In the VAD group,there were 146 cases in the ACIS group,133 cases in the PCIS group and 51 cases in the anterior and posterior circulation ischemic stroke mixed group;In the non-VAD group,63 cases in the ACIS group,34 cases in the PCIS group and 17 cases in the anterior and posterior circulation ischemic stroke mixed group.The differences in the history of hypercholesterolemia,previous stroke or TIA between the ACIS group,PCIS group and anterior and posterior circulation ischemic stroke mixed group were statistically significant(P<0.05).Comparing the clinical data between the VAD group and the non-VAD group,the history of drinking and the incidence of coronary heart disease in the VAD group were significantly higher than those in the non-vertebral artery dominance group,and the difference was statistically significant(P<0.05).The statistical results of VAD between the ACIS group,PCIS group and anterior and posterior circulation ischemic stroke mixed group confirmed that the incidence of vertebral artery dominance in the PCIS group was higher than that ACIS group(OR=1.688),and the difference was statistically significant(P<0.05).Multivariate logistic regression analysis confirmed that VAD is an independent risk factor for PCIS(OR>1,P<0.05).In posterior circulation ischemic stroke,the incidence of cerebral infarction among the four areas innervated by different blood vessels in the VAD group was higher than that in the non-VAD group,but the difference was not statistically significant(P>0.05).In the relationship between vertebral artery dominance and the infarcted side of the four different blood supply areas of the posterior circulation,the incidence of PCA area infarction on the same side of the dominant vertebral artery is higher,and the incidence of PICA area infarction on the opposite side of the dominant vertebral artery is higher,suggesting that in the presence of VAD,PCA area infarction tended to occur on the same side of the dominant vertebral artery,and PICA area infarction tended to occur on the opposite side of the dominant vertebral artery,but the difference was not statistically significant(P>0.05).Infarcts in SCA area tended to occur on the opposite side of the dominant vertebral artery,the difference was statistically significant(P<0.05).Conclusion:1.Vertebral artery dominance is an independent risk factor for posterior circulation ischemic stroke.2.SCA area infarctions with vertebral artery dominance mostly occur on the opposite side of the dominant vertebral artery.The incidence of PCA area infarction is higher on the same side of the dominant vertebral artery,and the incidence of PICA area infarction is higher on the opposite side of the dominant vertebral artery,suggesting that in the presence of VAD,PCA area infarction tends to occur on the same side of the dominant vertebral artery.PICA Regional infarction tends to occur on the opposite side of the dominant vertebral artery.3.Vertebral artery dominance combined with other risk factors for cerebrovascular disease(such as drinking history,coronary heart disease,etc.)will increase the risk of posterior circulation ischemic stroke.