椎动脉优势对基底动脉弯曲及椎基底动脉连接部脑梗死的影响

目的探讨椎动脉优势对基底动脉弯曲及椎基底动脉连接部位脑桥和小脑梗死的影响。方法选择单侧脑桥或小脑后下动脉供血范围的梗死患者91例(梗死组),分析影像学资料,包括梗死侧别、椎动脉优势、基底动脉弯曲和它们的方向性关系,另选健康体检者83例(对照组)。多因素分析基底动脉弯曲的预测因素。结果梗死组椎动脉优势常发生于左侧(P<0.01)。76例患者椎动脉优势与基底动脉弯曲呈反方向(P<0.01)。脑桥梗死发生于基底动脉弯曲的对侧,小脑后下动脉梗死发生于非优势椎动脉侧(P<0.01)。与对照组比较,梗死组基底动脉弯曲方向、基底动脉弯曲分级及右侧椎动脉直径差异有统计学意义(P<0.01)。多因素分析表明,椎动脉直径是预测基底动脉中、重度弯曲的惟一预测因素(OR=2.70,95%CI:1.22～5.98)。结论椎动脉流速不对称是基底动脉弯曲的重要血流动力学因素,这增加椎基底动脉连接部的脑梗死。     

基底动脉弯曲及其临床意义

随着神经影像学的发展,基底动脉弯曲检出率明显增高.基底动脉弯曲的发生和发展过程受年龄、基底动脉长度、椎动脉优势等因素的影响.基底动脉弯曲会影响后循环血液供应,并可能造成脑干和脑神经压迫导致相应的临床症状.     

椎-基底动脉形态与发生脑干梗死的关系: 623 例临床分析

目的研究基底动脉弯曲与双侧椎动脉粗细差异的关系,基底动脉弯曲及双侧椎动脉粗细不等与发生脑干梗死的关系。方法按时间顺序提取2005年7月至2006年7月进行头颅磁共振成像（MRI）和磁共振脑动脉造影（MRA）检查的623人的影像资料,观察基底动脉弯曲4个等级中双侧椎动脉粗细不等发生率、基底动脉弯曲方向与椎动脉细侧侧别一致率、基底动脉弯曲4个等级中脑干梗死发生情况及双侧椎动脉精细不等本中梗死发生情况。结果在基底动脉0至3度弯曲样本中,双侧椎动脉粗细不等的发生率分别为54%,85%,83%和80%,基底动脉0度组与1,2度组有显著差异。在基底动脉1至3度弯曲且双侧椎动脉粗细不等的样本中,椎动脉细侧所在侧别与基底动脉弯曲方向的一致率为83%。基底动脉无弯曲（0度弯曲）和基底动脉1至3度弯曲组间脑干梗死发生率无明显差异。双侧椎动脉粗细相等与不等组脑干梗死发生率无明显差异。结论在本组资料中,双侧椎动脉粗细不等可能是基底动脉弯曲的原因之一,基底动脉的弯曲程度及双侧椎动脉粗细不等对脑干梗死的发生未构成影响。     

基底动脉过长弯曲的3.OT MRI研究

目的 应用3.0T MRI研究基底动脉过长弯曲的影像学表现.方法 对MRI检查显示基底动脉过长弯曲患者155例行颅脑MRI及MRA检查,对基底动脉MR/及MRA各指标进行分析,观察患者脑实质情况.结果 基底动脉向右扭曲97例,向左扭曲58例;颅脑MRI平扫见后循环梗死或软化灶80例;基底动脉的位置与椎动脉的粗细相关(χ2=55.151,P<0.01).结论 MRI与MRA联合可清楚地显示基底动脉的形态、走行及其与后颅凹诸结构的关系.     

基底动脉弯曲对老年脑桥缺血性脑卒中患者的影响

目的探讨基底动脉弯曲对老年脑桥缺血性脑卒中患者的影响。方法根据84例急性脑桥缺血性脑卒中老年患者的磁共振血管造影(MRA)检查基底动脉是否弯曲,分为弯曲组(43例)和未弯曲组(41例)。选取40例同期住院的基底动脉弯曲但无脑桥缺血性脑卒中的眩晕或头晕患者作为对照组。详细记录三组患者的临床资料、血管危险因素等,测量基底动脉理论长度(BAL)、基底动脉弯曲长度(BL)、双侧椎动脉直径。结果 1弯曲组伴有吸烟、糖尿病、高血压、高胆固醇血症、高同型半胱氨酸血症、椎动脉优势的比例显著高于未弯曲组、对照组,其BAL、BL显著长于对照组(P0.05)。2吸烟(χ~2=10.091,P=0.001)、糖尿病(χ~2=8.174,P=0.004)、高血压(χ~2=7.641,P=0.006)、高胆固醇血症(χ~2=5.852,P=0.016)、高同型半胱氨酸血症(χ~2=5.208,P=0.022)、BL分级(3级:χ~2=4.817,P=0.028)是基底动脉弯曲患者发生脑桥缺血性脑卒中的危险因素。3BL 3级合并高血压、高同型半胱氨酸血症的比例高于BL 1、2级,BL 3级患者的右椎动脉直径短于BL 1级(P0.05)。4BL与椎动脉直径呈正相关(r=0.302,P0.05)。结论基底动脉弯曲能够增加老年患者脑桥缺血性脑卒中的风险,BL 3级是脑桥缺血性脑卒中的危险因素。     

椎动脉优势与基底动脉弯曲的关系及其与脑梗死关系的研究进展

<正>双侧椎动脉通常不对称,当差异明显时就成为一侧椎动脉优势(VAD),其对基底动脉弯曲的形成及后循环脑梗死的影响仍处于探索阶段,本文对上述情况进行简要综述。1椎-基底动脉解剖以及VAD椎-基底动脉经桥脑腹侧的基底动脉沟向上至中脑底端、脑桥顶端,发出左右各一条大脑后动脉和小脑下前动脉,此后穿过硬脑膜,发出供应颈髓的脊髓前动脉、脊髓后动脉和供应部分小脑和第四脑室脉络丛的小脑后下动脉(PICA)。脑动脉     

椎基底动脉磁共振血管造影特征与单纯性眩晕的相关性

目的 探讨头部磁共振血管造影(magnetic resonance angiography,MRA)显示的椎基底动脉形态学特征与单纯性眩晕之间的相关性.方法 回顾性纳入单纯性眩晕患者作为病例组,选取同时期无眩晕的其他患者作为对照组.收集临床资料和MRA数据,利用单变量分析和多变量logistic回归分析确定单纯性眩晕的独立危险因素.结果 共纳入单纯性眩晕患者118例,对照者179例.单变量分析显示,2组在左侧椎动脉弯曲度、基底动脉狭窄率以及既往眩晕史、既往卒中史、基底动脉延长扩张症、左侧和右侧椎动脉发育不良发生率方面存在统计学差异(P均<0.05).多变量logistic回归分析显示,既往眩晕史[优势比(odds ratio,OR)6.177,95%可信区间(confidence interval,CI)1.945~19.620;P=0.002]、左侧椎动脉弯曲程度较重(OR 1.860,95%CI 1.127~3.069;P=0.015)和左侧椎动脉发育不良(OR 4.543,95%CI 1.761~11.721;P=0.002)是单纯性眩晕的独立危险因素,而既往卒中史(OR 0.377,95%CI 0.162~0.877;P=0.024)和基底动脉发育不良(OR 0.401,95%CI 0.193~0.830;P=0.014)是其独立保护因素.结论 既往眩晕史、左侧椎动脉弯曲程度较重和左侧椎动脉发育不良是单纯性眩晕的独立危险因素,而既往卒中史和基底动脉发育不良可能是其独立保护因素.     

基底动脉过长弯曲的3．0T MRI研究

目的应用3．0T MRI研究基底动脉过长弯曲的影像学表现。方法对MRI检查显示基底动脉过长弯曲患者155例行颅脑MRI及MRA检查,对基底动脉MRI及MRA各指标进行分析,观察患者脑实质情况。结果基底动脉向右扭曲97例,向左扭曲58例;颅脑MRI平扫见后循环梗死或软化灶80例;基底动脉的位置与椎动脉的粗细相关（Х^2=55．151,P〈0．01）。结论MRI与MRA联合可清楚地显示基底动脉的形态、走行及其与后颅凹诸结构的关系。     

椎动脉优势促发血管性眩晕的机制

血管性眩晕是一种常见的眩晕.椎动脉优势是一种血管现象,其发生机制尚不清楚,可引起基底动脉改变和后循环血流动力学改变.椎动脉优势可通过多种机制促发血管性眩晕.     

后循环缺血性眩晕患者椎-基底动脉形态学改变

目的探讨后循环缺血性眩晕患者椎-基底动脉形态特点。方法回顾性分析122例后循环缺血性眩晕患者与同期60名无眩晕但有脑血管病危险因素的体检志愿者(对照组)的脑血管病相关危险因素、颈部CT血管成像及头部MR血管成像资料,将单因素比较的阳性指标采用多因素Logistic回归分析,筛查后循环缺血性眩晕患者的危险因素,并将后循环缺血组患者的椎动脉狭窄程度和基底动脉迂曲程度与对照组比较。结果 (1)后循环缺血组高血压、高脂血症、既往卒中或短暂性脑缺血发作病史、椎动脉粥样硬化性狭窄、椎动脉变异及基底动脉迂曲的发生率分别为59.0%(72例)、55.7%(68例)、64.8%(79例)、41.0%(50例)、28.7%(35例)及30.3%(37例),均明显高于对照组的33.3%(20例)、31.7%(19例)、35.0%(21例)、15.0%(9例)、10.0%(6例)及15.0%(9例),差异均有统计学意义(均P0.05)。(2)椎动脉粥样硬化性狭窄(OR=3.891,95%CI:1.721~8.800,P0.01)、椎动脉变异(OR=3.231,95%CI:1.238~8.432,P=0.017)及基底动脉迂曲(OR=2.664,95%CI:1.189~5.972,P=0.017)是后循环缺血性眩晕的独立危险因素。后循环缺血组椎动脉狭窄程度和基底动脉迂曲程度均高于对照组,差异均有统计学意义(均P0.05),椎动脉优势在基底动脉弯曲程度≥2级与2级间差异有统计学意义(P0.01)。结论椎动脉粥样硬化性狭窄、椎动脉变异及基底动脉迂曲是老年后循环缺血性眩晕的独立危险因素,而椎动脉优势是基底动脉迂曲的独立危险因素。     

Measurement of basilar artery bending and elongation by magnetic resonance cerebral angiography: relationship to age, sex and vertebral artery dominance

Elongation and bending of the basilar artery are frequently observed in both normal and pathological subjects. However, their mechanism of generation remain unclear. In the present study, we measured basilar arteries in patients and normal subjects using magnetic resonance angiography (MRA) and estimated the relationships between these anatomical changes and some factors such as age, sex and vertebral artery dominance. A total of 510 subjects underwent MRA. Basilar artery length (BAL), bending length (BL), or side of bending of basilar artery was estimated on the plain images including the basilar artery in two groups with and without vertebral union. BAL was longer in males than in females (P = 0.0009) and correlated with age (P < 0.0001) in the population with vertebral union, while BL did not differ between genders and was not correlated with age in this population. Both BAL and BL were longer in subjects with vertebral artery dominance than in subjects with equivalent-sized vertebral arteries in the population with vertebral union (P < 0.0001 and P = 0.0005). No difference in the frequency of basilar artery bending was observed between males and females and no correlation was observed between the frequency of basilar artery bending and ages in subjects without vertebral artery union. A significant negative correlation between the side of bending of the basilar artery and dominant side of vertebral arteries was found for group of all patients (P < 0.0001). BAL growth may mainly depend on aging, and the presence of vertebral artery dominance may contribute to the growth of BAL while BL growth may depend on vertebral artery dominance mainly in the contralateral direction.     

椎动脉优势眩晕患者的脑干听觉诱发电位变化及其临床意义

目的探讨椎动脉优势眩晕患者的脑干听觉诱发电位（BAEP）变化,了解椎动脉优势导致眩晕的可能机制。方法前瞻性连续纳人头部MR血管成像检查发现的椎动脉优势的眩晕患者35例作为研究组,以非椎动脉优势的眩晕患者29例作为对照组。两组患者的年龄、性别及其他临床病史具有可比性。对患者眩晕程度进行分级和BAEP检查,分析两组患者基底动脉情况、BAEP的变化及其与椎动脉优势的关系。结果入选的两组患者比较,①椎动脉优势和非优势两组比较,优势组基底动脉形状异常率为60．0％（21／35）,高于非优势组的34．5％（10／29）,差异有统计学意义,χ^2=4．135,P〈0．05;基底动脉弯曲度中位数为3．67mm,大于非优势组的1．73mm,差异有统计学意义,P〈0．01。②椎动脉优势组Ⅰ、Ⅲ、Ⅴ波峰潜伏期均长于非优势组（P〈0．01）,其中Ⅲ波差异未达统计学意义;椎动脉优势组Ⅲ～Ⅴ、Ⅰ～Ⅴ峰潜伏期均长于非优势组（P〈0．05）,而Ⅰ～Ⅲ峰问潜伏期差异无统计学意义（P〉0．05）;优势组（Ⅲ～Ⅴ）／（Ⅰ～Ⅲ）比值大于非优势组（P〈0．05）。③椎动脉优势患者眩晕程度级别（3．2±1．0）与非椎动脉优势患者（2．2±0．7）比较,差异有统计学意义（P〈0．01）。椎动脉优势眩晕程度等级与BAEP各主要异常指标之间有相关性,其中与Ⅲ～Ⅴ／Ⅰ～Ⅲ相关性最显著（r=0．617,P=0．013）。结论椎动脉优势眩晕患者基底动脉异常率高、BAEP异常发生率较高、眩晕程度级别高。椎动脉优势与BAEP异常有相关性。     

椎动脉优势与后循环缺血性卒中的相关性

目的 探讨椎动脉优势(vertebral artery dominance,VAD)与后循环缺血性卒中(posterior circulation ischemia stroke,PCIS)的相关性.方法 收集2013年11月至2015年10月期间住院治疗的连续急性缺血性卒中患者.所有患者均行MRI和磁共振血管造影(magnetic resonance angiography,MRA)检查.优势椎动脉定义为两侧直径相差≥0.3 mm时直径较大的椎动脉,或当两侧直径相差＜0.3 mm时与基底动脉直线连接的一侧椎动脉.依据牛津郡社区卒中计划(Oxfordshire Community Stroke Project,OCSP)分型标准将入选病例分为前循环缺血性卒中(anterior circulation ischemia stroke,ACIS)组和PCIS组.采用多变量logistic回归分析探讨VAD与PCIS的相关性.结果 共纳入226例急性缺血性卒中患者,ACIS组172例(76.1％),PCIS组54例(23.9％).54例(23.9％)存在VAD,其中左侧优势38例(70.3％),右侧优势16例(29.7％).PCIS组存在VAD的患者构成比显著高于ACIS组(55.6％对14.0％;x2=39.115,P＜0.001).多变量logistic回归分析显示,VAD是患者发生PCIS的独立危险因素(优势比13.60,95％可信区间6.90 ～27.01;P＜0.001).结论 VAD与PCIS发病密切相关,VAD是PCIS的独立危险因素.     

Massive pontine hemorrhagic infarction associated with embolic basilar artery occlusion

We report here an autopsy case of massive pontine hemorrhagic infarction secondary to embolic basilar artery occlusion. A large embolus appeared to have traversed the vertebral artery into the basilar artery as a result of basilarization of the vertebral artery due to severe stenosis of the contralateral vertebral artery. Extensive ischemia due to embolic occlusion of the entire length of the basilar artery, and migration of the embolus are assumed to have resulted in a massive pontine hemorrhagic infarction.     

基底平行解剖扫描磁共振成像联合磁共振血管成像动态监测颅内段椎动脉夹层二例并文献复习

脑血管影像学检查是目前诊断椎动脉夹层的主要依据,是观察动脉夹层形态学改变的重要手段.笔者回顾性分析了2例应用基底平行解剖扫描磁共振成像(BPAS-MRI)联合磁共振血管成像(MRA)显示血管外轮廓并动态监测血管形态学改变的颅内段椎动脉夹层患者的临床资料,并通过PubMed数据库以"Basi-parallel anato...     

Localization of atherosclerotic lesions in the human basilar artery

The topography of atherosclerotic lesions in the human basilar arteries has been studied quantitatively by digitizing images of the excised vessels and producing contour probability maps. Fifteen basilar arteries were obtained at autopsy (age--61 +/- 2; males--6, females--9; black--6, white--9), fixed in formalin, opened along the ventral aspect and stained grossly with Sudan IV to delineate fat-containing lesions. Photographs of the flattened arteries were analyzed and the presence or absence of sudanophilic lesions was determined at approximately 1000 identical sites on all vessels. The probability of finding a lesion at each site was determined and a contour probability map was constructed. Fifty-two percent of the area of the mean contour map was involved with lesions. The extent of the sudanophilic lesions decreased as one proceeded distally from the origin of the basilar artery at the confluence of the vertebral branches (i.e. proximal 1/3--56%; middle 1/3--49%; distal 1/3--43%; P less than 0.04). Significantly more sudanophilic material was observed on the ventral (outer curvature) as opposed to the dorsal (inner curvature) surfaces (55%, 43% respectively; P less than 0.03). These data suggest that hemodynamic forces associated with confluent flow and curvature may be important in the localization of sudanophilic lesions in the proximal and ventral aspects of the human basilar artery.     

椎动脉闭塞溶栓后并发基底动脉尖综合征1例及其处理

报道1例急性椎动脉闭塞急诊动脉溶栓后并发基底动脉尖综合征的处理过程.经机械和药物再次溶栓后椎动脉及基底动脉顶端分支血管通畅,患者预后良好,改良Rankin量表评分1分,提示动脉局部溶栓除对病灶本身有效外,对溶栓过程中新出现的栓塞并发症也有良好的效果.