Clinical Study On The Morphology Of Vertebro-basilar Artery In Patients With Acute Isolated Brainstem Infarction

Objective:To analyze the risk factors,clinical datas and morphological types of vertebro-basilar artery in patients with acute isolated brainstem infarction and to explore the relationship between various forms of vertebro-basilar artery and acute isolated brainstem infarction.Methods:Patients with acute cerebral infarction who were hospitalized in the Department of Neurology of the second Hospital of Jilin University from September 2019 to September 2021 were collected and their clinical datas including gender,age,past history,personal history,laboratory data and imaging data were compiled.According to the results of magnetic resonance imaging and diffusion weighted imaging,the patients were divided into acute isolated brainstem infarction group and acute non-brainstem infarction group.The morphological types of vertebro-basilar artery were analyzed,consing vertebral artery stenosis or occlusion,basilar artery stenosis or occlusion,vertebral artery tortuosity,basilar artery tortuosity,vertebral artery dominance,distal vertebral artery dissociation,origin variation of vertebral artery,vertebral artery fenestration,basilar artery fenestration,basilar artery dilatation.The datas were sorted out by SPSS 25.0 statistical software.The continuous variables were expressed by mean ± standard deviation and the differences between groups were analyzed by two-sample t-test.The classified variables were expressed by frequency and percentage and the differences between groups were compared by chi-square test.The variables with P < 0.05 of univariate analysis were included in multivariate Logistic regression analysis.Results:（1）160 patients with acute isolated brainstem infarction were surveyed which include 104 males（65.0%）and 56 females（35.0%）.The age was ranged from 37 to81 years old with an average age of 60.49 ± 8.82 years old.168 patients with acute non-brainstem infarction were collected which contained 120 males（71.4%）and 48females（28.6%）.The age was ranged from 39 to 77 years old with an average age of60.95 ± 7.70 years old.There was no statistical difference in gender and age（P >0.05）.（2）The predominant sites of acute isolated brainstem infarction were 121 cases of pons（75.63%）,27 cases of medulla oblongata（16.88%）,7 cases of mesencephalon（4.38%）,and 5 cases of mixed site（3.13%）.（3）In the acute isolated brainstem infarction group 42 cases（26.2%）had a history of stroke,22 cases（13.8%）had a history of cardiovascular disease,108cases（67.5%）had a history of hypertension,99 cases（61.9%）had a history of diabetes,59 cases（36.9%）had a history of smoking,61 cases（38.1%）had a history of drinking and there were 111 cases（69.4%）with overweight BMI（male ≥ 25,female≥24）.There were 77 cases（48.1%）of hypertriglyceridemia,55 cases（34.4%）of hypercholesterolemia,53 cases（33.1%）of low high-density lipoprotein,53 cases（33.1%）of high low-density lipoprotein,31 cases（19.4%）of hyperhomocysteinemia and 27 cases（16.9%）of hyperuricemia.In the acute non-brainstem infarction group58 cases（34.5%）had a history of stroke,20 cases（11.9%）had a history of cardiovascular disease,102 cases（60.7%）had a history of hypertension,61 cases（36.3%）had a history of diabetes,65 cases（38.7%）had a history of smoking,39cases（23.2%）had a history of drinking,and there were 100 cases（59.5%）with overweight BMI.The blood test indexes of admission showed that there were 70cases（41.7%）of hypertriglyceridemia,44 cases（26.2%）of hypercholesterolemia,69cases（41.1%）of low high-density lipoproteinemia,47 cases（28.0%）of high and low-density lipoproteinemia,58 cases（34.5%）of hyperhomocysteinemia and 29cases（17.3%）of hyperuricemia.There was no statistical difference in stroke,cardiovascular disease,hypertension,smoking history,overweight BMI,hypertriglyceridemia,hypercholesterolemia,low high-density lipoprotein,high and low-density lipoprotein and hyperuricemia（P > 0.05）.There were significant differences in diabetes,drinking history and hyperhomocysteinemia（P < 0.01）.（4）According to the results of computed tomographic angiography to judge the morphology of vertebro-basilar artery,in acute isolated brainstem infarction group there were 97 cases（60.6%）of vertebral artery stenosis or occlusion,including 32cases（20.0%）of mild stenosis,16 cases（10.0%）of moderate stenosis,49 cases（30.6%）of severe stenosis or occlusion,45 cases（28.1%）of basilar artery stenosis or occlusion,including 22 cases（13.8%）of mild stenosis,9 cases（5.6%）of moderate stenosis,14 cases（8.8%）of severe stenosis or occlusion,51 cases（31.9%）of vertebral artery dominance,32 cases（20.0%）of vertebral artery tortuosity,25cases（15.6%）of basilar artery tortuosity,15 cases（9.4%）of distal vertebral artery dissociation,9 cases（5.6%）of origin variation of vertebral artery,2 cases（1.3%）of vertebral artery fenestration,4 cases（2.5%）of basilar artery fenestration,2 cases（1.3%）of basilar artery dilatation.In acute non-brainstem infarction group there were 67 cases（39.9%）of vertebral artery stenosis or occlusion,including 33 cases（19.6%）of mild stenosis,14 cases（8.3%）of moderate stenosis,20 cases（11.9%）of severe stenosis or occlusion,37 cases（22.0%）of basilar artery stenosis or occlusion,including 24 cases（14.3%）of mild stenosis,8 cases（4.8%）of moderate stenosis,5cases（3.0%）of severe stenosis or occlusion（5.36%）,22 cases（13.1%）of vertebral artery dominance,20 cases（11.9%）of vertebral artery tortuosity（11.90%）,7 cases（4.2%）of basilar artery tortuosity,10 cases（6.0%）of distal vertebral artery dissociation,11 cases（6.6%）of vertebral artery origin variation,0 cases（0.0%）of vertebral artery fenestration,3 cases（1.8%）of basilar artery fenestration,1 case（0.6%）of basilar artery dilatation.There was no statistical difference in mild vertebral artery stenosis,moderate vertebral artery stenosis,mild basilar artery stenosis,moderate basilar artery stenosis,distal vertebral artery dissociation,vertebral artery origin variation,vertebral artery fenestration,basilar artery fenestration and basilar artery dilatation（P > 0.05）.There was statistical difference in severe basilar artery stenosis or occlusion and vertebral artery tortuosity（P <0.05）.There were significant differences in severe stenosis or occlusion of vertebral artery,vertebral artery dominance and basilar artery tortuosity（P < 0.01）.（5）Multivariate Logistic regression analysis showed that diabetes,drinking history,severe stenosis or occlusion of vertebral artery,severe stenosis or occlusion of basilar artery,vertebral artery dominance and vertebral artery tortuosity were independent risk factors of acute isolated brainstem infarction（OR > 1,P < 0.05）.Conclusion:1.The risk factors of acute isolated brainstem infarction are diverse,especially diabetes and drinking history.2.They were correlated with acute isolated brainstem infarction which include severe stenosis or occlusion of vertebral artery,severe stenosis or occlusion of basilar artery,vertebral artery dominance,vertebral artery tortuosity and basilar artery tortuosity.The morphological variation types of vertebro-basilar artery are conducive to evaluate the risk of acute isolated brainstem infarction.