Observation And Analysis Of Risk Factors Of Cerebral Infarction In Patients With Basilar Artery Stenosis

Objective Basilar artery atherosclerotic stenosis is one of the important causes of posterior circulation cerebral infarction.Compared with other vascular lesions of posterior circulation,the prognosis of posterior circulation cerebral infarction caused by basilar artery disease is worse.Our study aimed to analysis the risk factors for cerebral infarction in patients of basilar artery stenosis.Methods We consecutively recruited patients of basilar artery atherosclerotic stenosis ?50% from September 2017 to April 2019.Magnetic resonance angiography(MRA)was used to assess the degree of stenosis of the basilar artery and intracranial vertebral artery,the presence of fetal-type posterior cerebral artery and intracranial vertebral artery hypoplasia,and posterior collateral circulation.Cervical ultrasound was used to assess the degree of stenosis of the extracranial vertebral artery and the presence of extracranial vertebral artery hypoplasia.The severity of white matter hyperintensities(WMHs)and old lacunar infarction was also assessed on conventional magnetic resonance imaging.Demographic data,risk factors for cerebrovascular disease,and data of relevant blood tests were recorded.All the recruited patients were divided into two groups(stroke and non-stroke groups)according to the presence of cerebral infarction in the area supplied by basilar artery.The clinical and imaging data were compared between the stroke group and the non-stroke group on the risk factors of cerebral infarction in patients of basilar artery stenosis.BATMAN(Basilar Artery on Computed Tomography Angiography)score was evaluated in patients of nonvisible signals of basilar artery,among whom the clinical data and imaging data were compared between stroke and non-stroke patients..Results1.Among the 175 enrolled patients,122 patients had infarction(69.7%)and 53 patients had no infarction(30.3%)in the area supplied by basilar artery.The age of the 175 patients was 71.00(63.00,79.00),males accounted for 60.6%(106/175)and females accounted for 39.4%(69/175).2.Compared with the non-stroke patients,the admission systolic blood pressure(160mm Hg vs 149 mm Hg,P=0.002)and diastolic blood pressure(87 mm Hg vs.79 mm Hg,P=0.006)were higher in the stroke patients.The proportion of fetal-type posterior cerebral artery(43.4% vs.66.0%,P=0.006)in the stroke patients was lower than that of the non-stroke patients.Compared with the non-stroke patients,the proportion of lacunar infarction graded 2(number of lesions?4)(49.2% vs.18.9%,P=0.001)and the proportion of moderate/severe WMHs(graded 3 to 6)(64.8% vs.37.7%,P=0.001)were higher in the stroke patients.Multivariate logistic regression analysis showed that the admission diastolic blood pressure(OR=2.438,95%CI 1.094-5.435,P=0.029)was higher in the stroke patients.The proportion of fetal-type posterior cerebral artery(OR=0.378,95%CI 0.179-0.801,P=0.011)was lower in the stroke patients.The lacunar infarction graded 2(OR=2.563,95%CI 1.094-6.003,P=0.030)and moderate to severe WMHs(OR=2.473,95% CI 1.144-5.345,P=0.021)were independently associated cerebral infarction in the area supplied by basilar artery in patients of basilar artery stenosis.3.There were 64 patients of nonvisible signals of basilar artery,including 42 males(65.6%)and 22 females(34.4%)with an average age of(68.91±11.52)years.Among the 64 patients,48 patients had infarction(75%)and 16 patients had no infarction(25%)with a median BATMAN score 6.00(5.00,7.00).Compared with the non-stroke patients,the proportion of BATMAN score <7(68.8% vs.25.0%,P=0.002),lacunar infarction graded 2(43.8% vs.12.5%,P=0.024)and moderate to severe WMHs(54.2% vs.25.0%,P=0.043)was higher in the stroke patients.Multivariate logistic regression analysis showed that BATMAN score <7(OR=0.134,95% CI 0.030-0.604,P=0.009)was an independent risk factor for cerebral infarction in patients of nonvisible signals of basilar artery.Conclusion1.The proportion of fetal-type posterior cerebral artery was lower in the stroke patients than that of the non-stroke patients.2.Lacunar infarction graded 2(number of lesions?4),moderate/severe WMHs(graded 3 to 6)and poor collateral circulation(BATMAN score <7)were independent associated with the infarction in patients of basilar artery stenosis.