Clinical Study Of Posterior Circulation Ischemia And Vertebrobasilar Artery Variation

Object:Vertebral artery dominance(VAD)refers to the linear connection between VA and BA when the diameter of both sides of VA is larger or the diameter of both sides is equal.35.5-58%of the population have left VAD,and right VAD is 19-35.7%.[8,9].Research at this stage believes that VAD may be a risk factor for PCI[10].Compared with anterior circulation ischemia,patients with posterior circulation ischemia have a significantly higher incidence of vertebral artery diameter asymmetry,which is related to the curvature of the basilar artery(Basilar Artery,BA)[11].BA is the only artery in the human body that is formed by the merger of two arteries,with special hemodynamic changes.Explore the hemodynamic changes that occur at the vertebral-basal artery junction when VAD occurs,study the formation of vertebral artery dominance,analyze its involvement in basilar artery bending,and their involvement in the process of posterior circulation ischemia,which is helpful for PCI The formation mechanism and diagnosis and treatment provide new ideas and references.Method:Taking 123 PCI patients and 53 healthy outpatient physical examination patients who were hospitalized in the Second Department of Neurology of the First Hospital of Jilin University between July 2019 and December 2020 as the research objects,the clinical data of the above 176 patients were collected.All patients have completed cranial MRI,MRA,transcranial color Doppler ultrasound,and carotid artery color Doppler.According to the diameter of the bilateral vertebral arteries measured by carotid color ultrasound,combined with transcranial color Doppler ultrasound and cranial MRA,the study The subjects were divided into vertebral artery dominant group(VAD group)and vertebral artery non-dominant group(non-VAD group).Detailed records of each patient’s clinical data,common risk factors for cerebrovascular diseases,and assessment of risk factors through laboratory tests.Results:1.Vertebral artery in extracranial VAD group:Vs,Vd,Vm:dominant side>non-dominant side(P<0.05);RI:dominant side<non-dominant side(P<0.05);dominant side vertebra in extracranial VAD group Artery compared with bilateral vertebral arteries in non-VAD group:Vs,Vd,Vm:VAD group>non-VAD group(P<0.05);RI:dominant group<non-VAD group(P<0.05);intracranial segment VAD group vertebral artery:Vs,Vd,Vm:dominant side>non-dominant side(P<0.05);PI,RI:dominant side<non-dominant side(P<0.05);intracranial VAD group dominant vertebral artery and non-Comparison of bilateral vertebral arteries in VAD group:Vs,Vd,Vm,VAD group>non-VAD group(P<0.05);PI,RI:superior group<non-VAD group(P<0.05);2.VAD group and dominant side and non-dominant posterior cerebral artery:Vs,Vd,Vm:dominant side>non-dominant side(P<0.05),PI,RI:statistically no significant difference(P>0.05);VAD There was no significant difference in basilar artery Vs between the non-VAD group and the non-VAD group(P>0.05),Vd,Vm:VAD group<non-VAD group(P<0.05);PI,RI:VAD group>non-VAD group(P<0.05);theoretical length of basilar artery:VAD group>non-VAD group(P<0.05);basilar artery curvature:VAD group>non-VAD group(P<0.05);3.Among the 176 patients,123 were PCI patients,including 64 patients with posterior circulation TIA and 59 patients with posterior circulation cerebral infarction;53 patients in the healthy control group,and 8 patients in the healthy control group with BA moderate/severe curvature(accounting for 15.1%);There were 22 patients with BA moderate/severe curvature in circulatory TIA patients(34.4%);30 patients with BA moderate/severe curvature in patients with posterior circulation cerebral infarction(50.8%).The correlation analysis of the three factors of PCI,BA bending,and VAD indicates that there is a positive correlation between the two;4.The severity of posterior circulation ischemia is related to basilar artery curvature and vertebral artery superiority.Basilar artery curvature is grade 3,grade 2,and grade 1.Compared with people with grade 0 curvature,posterior circulation ischemia is at least one grade more likely They are 7.565(P=0.001),2.042(P=0.182),2.701(P=0.021)times.Compared with people without vertebral artery dominance,the possibility that posterior circulation ischemia is at least one grade severe is 5.062(P<0.001)times.Conclusion:1.In patients with posterior circulation ischemia,the blood flow velocity of the vertebral artery in patients with vertebral artery dominance is significantly higher than that of the non-dominant side and patients without vertebral artery dominance,and the blood flow velocity of posterior cerebral artery in patients with vertebral artery dominance is significantly higher than that of non-dominant patients.side.2.Among patients with posterior circulation ischemia,the blood flow velocity of the basilar artery in patients with vertebral artery dominance is significantly lower than that of patients without vertebral artery dominance,and the curvature and theoretical length of the basilar artery are significantly higher than those without vertebral artery dominance.3.The posterior circulation ischemia,the degree of basilar artery curvature and the vertebral artery dominance are correlated.The presence of vertebral artery superiority and the higher the degree of basilar artery curvature,the higher the severity of posterior circulation ischemic events.