| Background:Vertebral artery dysplasia,characterized by one vertebral artery slender and significantly smaller in diameter,is considered a normal congenital vascular variant.Vertebral artery dysplasia is common in patients with posterior circulation ischemia and is a precipitating factor or even an independent risk factor for posterior circulation infarction,the specific pathogenesis of which is not well understood.Previous studies have reported a higher incidence of vertebral artery dysplasia in patients with posterior circulation infarction compared with asymptomatic patients or those with cerebral infarction at other sites.Therefore,it is of certain clinical value to clarify the relationship between vertebral artery dysplasia and posterior circulation infarct infarct infarct site location,vascular morphology and plaque characteristics.Objective:This study was to investigate investigate the relationship between vertebral artery hypoplasia(VAH)and the location,vascular morphology and plaque features of acute single posterior circulation infarction(PCI).Methods:A total of 477 patients with acute solitary posterior circulation infarction who were hospitalized for the first time in the Department of Neurology of Shandong Provincial Hospital from March 2013 to December 2020 were retrospectively included.According to the results of DSA examination,477 patients were divided into the VAH group(209 cases)and the non-VAH group(268 cases).According to the side of VAH,the VAH group was further divided into the side of VAH(127 cases)and the side of non-VAH(82 cases).Age,sex,body mass index,smoking history,hypertension history,diabetes history,coronary heart disease history,baseline blood pressure,fastingblood glucose,low-density lipoprotein,homocysteine,uric acid,creatinine,fibrinogen,posterior circulation infarct site(proximal,middle and distal segment),vertebral artery dysplasia,basilar artery curvature index,basilar artery curvature and protrusion index,vertebral artery intracranial stenosis,vertebral artery ostium angle,embryonic posterior cerebral artery were compared between the two groups.The plaque characteristics(plaque area,plaque load,remodeling index,mode of vascular remodeling[positive remodeling,negative remodeling and non-remodeling],degree of plaque enhancement[no enhancement,mild enhancement,significant enhancement],and plaque morphology[eccentric and concentric])were compared between the two groups.Results:The proportion of proximal,middle and distal infarcts in the VAH group was 22.0%(46/209),40.7%(85/209)and 37.3%(78/209),respectively.The proportion of proximal,middle and distal infarcts in the non-VAH group was 13.1%(35/268),45.1%(121/268)and 41.8%(1 12/268),respectively.The difference of infarct location between the two groups was statistically significant(χ2=6.674,P=0.036).In the VAH group,the proportion of proximal,middle and distal infarcts of VAH were 27.6%(35/127),35.4%(45/127)and 37.0%(47/127),respectively.The proportion of proximal,middle and distal infarcts with VAH was 13.4%(11/82),48.8%(40/82)and 37.8%(31/82),respectively.There was a statistically significant difference in the distribution of infarcts on both sides(χ2=6.720,P=0.035).(3)The ratio of intracranial stenosis of vertebral artery,embryonal posterior cerebral artery,basilar artery curvature and basilar artery curvature index in the VAH group were higher than those in the non-VAH group,and the differences between groups were statistically significant(46.9%[98/209]vs.20.5%[55/268],χ2=37.47.31.1%[65/209]vs.13.1%[35/268],χ2=23.066;73.7%[154/209]vs.56.0%[150/268],χ2=29.192;0.06[0.00,0.08]vs.0.03[0.00,0.06],Z=-3.228;P<0.01);There was no significant difference in the proportion of acute angle of vertebral artery ostium between the two groups(P>0.05).In the VAH group,the proportion of basilar artery curvature and protrusion on the hypoplasia side was higher than that on the non-hypoplasia side,and the difference was statistically significant(80.3%[102/127]vs.63.4%[52/82],P<0.01].There were no significant differences in intracranial segment stenosis of vertebral artery,the proportion of embryonal posterior cerebral artery and vertebral artery ostium and the index of basilar artery curvature between the dysplastic side and the normal side(all P>0.05).(4)Among 153 patients with intracranial segment stenosis of vertebral artery,140 had responsible plaque,with 92 in VAH group and 48 in the non-VAH group.The responsible plaque load in the VAH group was higher than that in the non-VAH group,and the difference between groups was statistically significant(80.4[69.7,86.2]%vs.75.1[65.3,81.6]%,Z=-2.173,P<0.01).There were no significant differences in responsible plaque area,remodeling index,remodeling pattern,enhanced plaque and plaque morphology between the two groups(all P>0.05).Summary and conclusions:The distribution of infarct site was different in posterior circulation infarction patients with VAH and without VAH.Compared with patients with posterior circulation infarction but without VAH,patients with posterior circulation infarction and VAH had higher vertebral artery stenosis ratio,embryonic posterior cerebral artery ratio,basilar artery curvature ratio,basilar artery curvature index,and intracranial segment responsible plaque load.In posterior circulation infarction complicated with VAH,the infarct location distribution on the side with VAH was different from that on the side without VAH,and the ratio of basilar artery curvature and convexity and intracranial segment responsible plaque load on the side with VAH were higher than those on the side without VAH.Although there is no effective clinical treatment for VAH,it should be regularly screened and followed up to reduce or avoid posterior circulation infarction. |
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