Relationship Between Vertebrobasilar Dolichoectasia And Posterior Circulation Ischemic Stroke

Objectives:By retrospectively analyzing the clinical data and imaging characteristics of patients with VBD,to explore the characteristics of BA and VA tortuosity,dilation and extension,the risk factors of VBD combined with ischemic stroke,the prone sites and vascular imaging characteristics,and to understand the relationship between VBD and posterior circulation ischemic stroke.Methods:About 1059 patients diagnosed with VBD who underwent head and neck vascular CTA examination in the CT room of YuXi People’s Hospital from November 2017 to April 2019 were selected.The patients were screened through image reading,then recorded the basic information,risk factors,main diagnosis and imaging examination results of the patients who were diagnosed VBD.Divided the VBD patients into cerebral infarction group and non-cerebral infarction group,and the site of cerebral infarction was further divided.Used SPSS 26.0 statistical software to analyze date.T-test and chi-square test were used to compare the data of the two groups,when P<0.05,the difference was considered to be statistically significant.Results:A total of 905 patients with diagnosed VBD were screened out in 1059 patients,including 668 patients with complicated cerebral infarction,198 patients with new posterior circulation cerebral infarction,and 282 patients with new anterior circulation cerebral infarction.The mean age,male,proportion of hypertension,atherosclerosis,coronary heart disease,dyslipidemia and diabetes in the VBD group with cerebral infarction were all higher than those in the non-cerebral infarction group,and the proportion of cerebral hemorrhage and aneurysm was lower than that in the non-cerebral infarction group.Except for coronary heart disease,the above comparisons were statistically significant.The mean age of VBD combined with posterior circulatory cerebral infarction group was lower than that of anterior circulatory cerebral infarction group and had statistical significance.The proportion of other risk factors was higher than that of anterior circulatory cerebral infarction group,but had no statistical significance.VBD combined with posterior circulation cerebral infarction sites were more common in pons(39.39%)and thalamus(33.33%),but less in midbrain and medulla oblongata.The mean diameter of BA in patients with confirmed VBD was(5.491-0.9281)mm.The BA diameter of VBD patients with cerebral infarction was generally higher than that of the non-cerebral infarction group,and P<0.05.The BA diameter of VBD patients with posterior circulation cerebral infarction was not significantly different from that of anterior circulation cerebral infarction group.The BA bifurcation height of 905 VBD patients was 467 in grade 2 and 368 in grade 3,and the BA horizontal deviation was 249 in grade 1 and 437 in grade 2.The transflexion morphology of VA was divided into left vertebral right-flexion type,right vertebral left-flexion type and mixed type.The tortuousness of VA,the biforking height and the horizontal deviation of BA between the VBD group with cerebral infarction and the non-cerebral infarction group,and between the VBD group with posterior circulatory cerebral infarction and the anterior circulatory cerebral infarction group were no significant differences in the results of the joint list chi-square test(P>0.05).Conclusions:VBD is a chronic progressive disease.With the increase of age,the risk of cerebral infarction in patients with VBD tends to increase.Male,hypertension,atherosclerosis,dyslipidemia and diabetes mellitus are closely related to cerebral infarction.The above risk factors except age had no significant correlation with the site of cerebral infarction,in VBD with anterior circulation and posterior circulation cerebral infarction group.Pons infarction is the most common-in the posterior circulation cerebral infarction caused by VBD,thalamus,occipital lobe and cerebellar infarction is not uncommon,and the incidence is higher than the previous results.In the observation and measurement of blood vessels in VBD patients,it was found that BA diameter presented positive skewness distribution,and the diameter of the vast majority of patients(93.17%)was within the range of(4.50-6.99)mm.With the enlargement of BA diameter,the risk of cerebral infarction may increase.The BA height and the offset were at the maximum of level 2.Some patients with VBD had VA tortuosity to contralateral,and the incidence of left vertebral right-flexion was similar to that of right vertebral right-flexion,and mixed type was rare.