Correlation Between Vertebral Artery Dissection And Arterial Tortuosity Evaluated By CT And MR Angiography

Part I Correlation Analysis of Vertebral Artery Dissection and Arterial Tortuosity based on TOF-MRAObjective:To analyze the risk factors of vertebral artery dissection,and explore the relationship between vertebral artery dissection and the degree of vertebrobasilar artery tortuosity based on time-of-flight magnetic resonance angiography(TOF-MRA).Methods:A total of 30 patients with vertebrobasilar artery dissection and 35 healthy control subjects matched in age and sex were included in the study.The clinical characteristics and vascular morphological characteristics of vertebrobasilar artery between the two groups were compared byx~2 test,t test or Mann-Whitney U test.Pearson or Spearman were used to analyze the correlation between each index and the occurrence of vertebrobasilar artery dissection.Results:The difference of hypertension(x~2=4.091,P=0.043)between the two groups was statistically significant,while the other clinical characteristics were not statistically significant between the two groups.Compared with the morphological characteristics of the vertebrobasilar artery between the two groups,the differences of the minimum bending angle of the basilar artery,the minimum bending angle of the V4 segment of the vertebral artery and the minimum bending angle of the vertebrobasilar artery were statistically significant(P<0.001).Correlation analysis showed that the minimum bending angle of the basilar artery,the minimum bending angle of the V4 segment of the vertebral artery and the minimum bending angle of the vertebrobasilar artery were negatively correlated with the occurrence of vertebral artery dissection(r=-0.574,-0.581,-0.592).Conclusions:The results of this study suggest that hypertension is a risk factor for the occurrence of vertebral artery dissection,and excessive curvature of vertebrobasilar artery plays an important role in the occurrence of vertebral artery dissection.Part II The role of vertebral artery tortuosity in posterior circulation ischemic strokeObjectives: The purpose is to further explore whether there is a difference in the degree of vertebral artery tortuosity between vertebral artery dissection and other cerebrovascular diseases that cause posterior circulation ischemic stroke,and to evaluate the influence of vertebral artery superiority on the occurrence of posterior circulation infarction.Methods: A total of 72 patients with posterior circulation ischemic stroke(VAD PC IS)caused by vertebral artery dissection and 76 patients with posterior circulation ischemic stroke(non-VAD PC IS)caused by other cerebrovascular diseases were included in this study,and 140 healthy subjects were included as healthy controls.Collect the clinical data of all subjects,evaluate the vertebral artery tortuosity index(VTI)and the existence of dominant vertebral artery by CT and MR angiography,and establish a multiple regression model to evaluate the risk factors of posterior circulation ischemic stroke.Results: The statistical results showed that the prevalence of hypertension in VAD PC IS group was higher than that in non-VAD PC IS group and healthy control group(P=0.002).The intergroup analysis showed that there was a statistical difference between VAD group and healthy control group(P=0.016),and other clinical characteristics were not statistically significant.Multiple regression analysis showed that hypertension was an independent risk factor for vertebral artery dissection(OR,3.189;95% CI,1.617-6.290,P=0.001).The median VTI of VAD PC IS group(29.46,19.99-42.34)was higher than that of non-VAD PC IS group(27.19,20.00-36.08)and healthy control group(24.48,16.78-30.59;P=0.031).Intergroup analysis showed that there was statistically significant difference between VAD PC IS group and healthy control group(P=0.032),and there was no statistical difference between the other groups.Multiple regression analysis showed that VTI was independently associated with the risk of vertebral artery dissection(OR,1.041;95% CI,1.016-1.066,P=0.001).There were 52 vertebral artery advantages in VAD PC IS group,42 in non-VAD PC IS group and 73 in healthy control group.The superiority of vertebral artery was statistically different among the three groups(P<0.001).Multivariate regression analysis showed that the advantage of the contralateral vertebral artery of the affected vessel was independently associated with the risk of VAD PC IS group(OR,4.024;95% CI,1.890-8.567,P<0.001),and the advantage of the contralateral vertebral artery of the affected vessel was independently associated with the risk of nonVAD PC IS group(OR 2.235,95% CI,1.151-4.342,P=0.018).The advantage of vertebral artery is the risk factor of posterior circulation ischemic stroke.Conclusions: The results of this study show that compared with other cerebrovascular diseases that cause posterior circulation ischemic stroke,the arterial curvature of patients with vertebral artery dissection is usually greater,and the existence of vertebral artery advantage is significantly related to posterior circulation ischemic stroke,which may help to better understand the pathophysiology of the disease and evaluate and predict it.