Correlation Between Blood Pressure Variability And High-resolution Imaging Features Of Vascular Wall Of Craniocervical Artery Dissection

Research Background:High-resolution magnetic resonance vascular wall imaging(HR-MRI)has been widely used in the diagnosis of head and craniocervical artery dissection(CCAD).Typical CCAD signs in HR-MRI include intimal flap,double-lumen sign,intramural hematoma,intraluminal thrombus,pseudoaneurysm,irregular surface.Among them,Intraluminal thrombus is likely to lead to vascular occlusion or embolization and thus ischemic stroke;Irregular surface may lead to microthrombus formation due to intima damage,which is also associated with ischemic stroke;In addition,dissection pseudoaneurysm(d PSA)can become the focus of thromboembolism,prone to ischemic stroke,and d PSA can also cause space occupying effect on adjacent structures and lead to cranial nerve paralysis.If intracranial d PSA ruptures,subarachnoid hemorrhage will be caused.Therefore,it is very important to study the causes of pseudoaneurysm,intraluminal thrombus and irregular surface.The purpose of this study was to investigate the risk factors of pseudoaneurysm,intraluminal thrombus and irregular surface in CCAD patients on HR-MRI,Further research on the mechanism of CCAD is expected to contribute to the diagnosis,treatment and prognosis of CCAD.Research Methods:We retrospectively collected 87 hospitalized patients diagnosed with CCAD in the Department of Neurology of our hospital from January 2020 to November 2022.All patients received HR-MRI examination within 7 days after admission.A total of75 patients were included in the study after excluding 3 patients whose diagnosis was affected by large HR-MRI image artifacts,5 patients with incomplete clinical data,and 4 patients who had received interventional surgery before HR-MRI.The imaging features of dissection were measured by two neuroimaging doctors,who were divided into pseudoaneurysm group and non-pseudoaneurysm group,intraluminal thrombus group and non-intraluminal thrombus group,irregular surface group and non-irregular surface group according to the features of dissection.Demographic,clinical and laboratory data of patients were collected.And HR-MRI features such as dissection location,double-lumen sign,intimal flap,intramural hematoma,intraluminal thrombus,irregular surface,pseudoaneurysm,and involved artery,clinical and imaging features were compared between the two groups.All statistical analyses were performed using SPSS 27.0.Chi-square test or Fisher’s exact test was used for categorical variables,and Student’s t test or Mann-Whitney U test was used for continuous variables to compare the differences between the two groups.Multivariate logistic regression model was used to analyze the risk factors of pseudoaneurysm,intraluminal thrombus and irregular surface.Research Results:In this study,75 patients were included,male accounting for 88%,ranging in age from 23 to 72 years old,with an average age of 48.01 ± 13.89 years old.Each patient had only 1 dissection,with a total of 75 intersections..1.According to the presence or absence of pseudoaneurysm,the patients were divided into pseudoaneurysm group(13 cases)and non-pseudoaneurysm group(62cases).There were statistical differences between the two groups in age,leukocyte level,high density lipoprotein level,urea nitrogen level,intimal flap,intramural hematoma and irregular surface.Age,urea nitrogen level,high density lipoprotein level,irregular surface incidence(53.8% vs 24.2%,P < 0.05),incidence of intimal flap(100% vs 58.1%,P < 0.05)were higher than those in the non-pseudoaneurysm group,and the incidence of leukocyte level and intramural hematoma in the non-pseudoaneurysm group(61.3% vs 23.1%,P < 0.05)were higher than those in the pseudoaneurysm group,and there were no significant differences between the two groups in gender,body mass index(BMI),hypertension,diabetes,head and neck trauma history,intracranial location,involvement and incidence of arterial,double-lumen sign and intraluminal thrombus.After adjusting for age,sex and etiological variables(P < 0.05)and other confounding factors,urea level,high density lipoprotein level,intramural hematoma incidence and irregular surface incidence were still significant after multivariate analysis(P < 0.05).2.According to the presence of intraluminal thrombus,the patients were divided into intraluminal thrombus group(36 cases)and non-intraluminal thrombus group(39cases).Univariate analysis found no statistical differences in demographic,clinical and laboratory characteristics between the two groups.There were no significant differences between the intraluminal thrombus group and the non-intraluminal thrombus group in intracranial location,double-lumen sign,irregular surface,pseudoaneurysm,involvement and artery.However,the incidence of hematoma in the intraluminal thrombus group was higher than that in the non-intraluminal thrombus group(86.1% vs 25.6%,P < 0.001).After adjusting for confounding factors such as age,sex,and intimal flap(P < 0.05),intramural hematoma was an independent risk factor associated with intraluminal thrombus(P < 0.05).3.They were divided into irregular surface group(22 cases)and non-irregular surface group(53 cases).Univariate analysis found no statistical differences in demographic,clinical and laboratory characteristics between the two groups.There were no significant differences between irregular surface group and non-irregular surface group in intracranial location,double-lumen sign,intimal flap,intramural hematoma,intraluminal thrombus,involvement and artery.However,the incidence of pseudoaneurysm in the irregular surface group was higher than that in the non-irregular surface group(31.8% vs 11.3%,P < 0.05).After adjusting for confounding factors such as age and sex,no pseudoaneurysm was found to be associated with irregular surface.Research Conclusion:1.Urea nitrogen level,high density lipoprotein level,intermural hematoma and irregular surface are closely related to the presence of pseudoaneurysm in patients with craniocervical artery dissection,and all of them may be independent risk factors for pseudoaneurysm.2.Intermural hematoma is closely related to the presence of intraluminal thrombus in patients with craniocervical artery dissection,and may be an independent risk factor for intraluminal thrombus.