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脑桥和小脑梗死的影响. 方法 回顾性分析郑州人民医院神经内三科自2009年1月至2011年1月收治的91例单侧脑桥或小脑后下动脉脑梗死患者的影像学资料,包括梗死侧别、椎动脉优势、基底动脉弯曲及其方向性关系等,应用多元logistic回归分析寻找基底动脉弯曲的预测因素. 结果 旁正中动脉供血区的脑桥中央是脑桥梗死最多的受累部位,右侧小脑内下部是小脑后下动脉梗死最多的受累部位.椎动脉优势常发生于左侧(69.2％,63/91).91例患者中有76例在椎动脉优势和基底动脉弯曲之间存在相反方向的关系.椎动脉内径是基底动脉中重度弯曲的唯一预测因素,其OR值为2.70,95％CI为1.22～5.98. 结论 椎动脉优势是基底动脉弯曲的重要预测因素,且弯曲多朝向优势椎动脉的对侧.椎动脉优势及其造成的基底动脉弯曲增加了椎基底动脉连接部脑梗死的发生率.

Vertebral artery dominance affects basilar artery curvature and vertebrobasilar junctional infarct

Objective To investigate the effect of vertebral artery (VA) dominance on basilar artery (BA) curvature and pontine or cerebellar infarct occurring around the vertebrobasilar junction of VA. Methods Radiological data (infarct laterality,VA dominance,BA curvature and their directional relationships) were analyzed in 91 patients with acute unilateral pontine or posterior inferior cerebellar artery (PICA) territory infarcts.Multiple regression analysis was performed to predict the moderate to severe BA curvature. Results The dominant VA frequently happened on the left side.Most patients had an opposite directional relationship between the dominant VA and BA curvature. Pontine infarct frequently happened opposite to the side of BA curvature and PICA infarct on the same side as the non-dominant VA side.The VA diameter was the only independent predictor for moderate to severe BA curvature (OR: 2.70; 95％CI: 1.22-5.98). Conclusion VA dominance is an important predictive factor of BA curvature,and BA curvature is usually opposite to the side of BA curvature; VA dominance and BA curvature caused by VA dominance increase the incidence of vertebrobasilar junctional infarcts.