症状性椎动脉狭窄与脑干和小脑梗死关系研究

目的探讨狭窄≥50％的椎动脉狭窄与脑干和小脑梗死的关系。方法回顾性收集经256层螺旋CT血管成像证实有≥50％的症状性椎动脉狭窄54例，引起脑干或小脑梗死。分析症状性椎动脉狭窄的不同部位特点与脑干和小脑梗死的关系。结果椎动脉狭窄引起脑干梗死，腔隙性梗死明显多于区域性梗死（x^2=7．84，P＜0．05），引起小脑梗死，区域性梗死明显多于腔隙性梗死（x^2=10．71，P＜0．01）。动脉粥样硬化斑块见于45．45％脑干梗死的患者和71．43％小脑梗死患者。椎动脉发育不良见于18．19％脑干梗死的患者和14．29％小脑梗死患者。脑干梗死组中椎动脉颅内段（V4段）狭窄占42137％，明显高于小脑梗死组（22．44％，x^2=6．25，P＜0．05）。小脑梗死组中，椎动脉颅外段（V1段）狭窄占36．73％。明显高于脑干梗死组（20．33％，x^2=5．07，P＜0．05）。脑干梗死组合并基底动脉狭窄率为12．12％，明显高于小脑梗死组（4．26％，X^2=4．00，P＜0．05）。结论引起脑干和小脑梗死的症状性椎动脉颅内、外段狭窄部位有差异，对脑干和小脑梗死患者尽快进行有效的血管评价，对于选择药物治疗和血管内治疗有重要意义。

Relationship between symptomatic vertebral artery stenosis with brainstem/cerebellar infarction

Objective To investigate the correlation between ≥50% apparently symptomatic vertebral stenosis and the brainsteIn/cerebellar infarction. Methods 54 patients with ≥50% apparently symptomatic vertebral stenosis detected by 256-multislice CT angiography （CTA） were admitted retrospectively. Vertebral stenosis resulted in brainstem/cerebellar infarction. The symptomatic vertebral artery stenosis characteristics in brainstem/cerebellar infarction were analyzed. Results Lacunar infarction in brainstem infarction group due to vertebral artery stenosis was significantly more than territorial infarction （X^2=7.84, P 〈0.05）. Territorial infarction in cerebellar infarction group was significantly more than lacunar infarction （x^2=-10.71, P 〈0.01）. Atherosclerotic plaques were found in 45.45%/71.43% of the cases with brainstem/ cerebellar infarction respectively. Vertebral artery hypoplasia was found in 18.19%/14.29% of the cases with brainstem/ cerebellar infarction respectively. The intracranial vertebral artery （V4 segment） stenosis was significantly higher in the brainstem infarction group （42.37%） than that in the cerebellar infarction group （22.44%, X^2=6.25, P 〈0.05）. The proximal vertebral artery （V1 segment） stenosis was significantly higher in the cerebellar infarction group （36.73%） than that in the brainstem infarction group （20.33%, X^2=5.07, P 〈0.05）. The prevalence of basilar artery stenosis complicated with vertebral artery stenosis was significantly higher in the brainstem infarction group （12.12%） than that in the cerebellar infarction group （4.26%, X^2=4.00, P 〈0.05）. Conclusion The differences of symptomatic extra/intracranial vertebral artery in brainstem/cerebellar infarction indicate that patients with brainstem/cerebellar infarction should be evaluated by image technologies effectively as soon as possible, which will provide the reliable basis of drug treatment and endovascular treatment.