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。

Influence of vertebral artery dominance on cerebral infarctions at junctions between basilar artery curvature and vertebrobasilar artery

Objective To investigate the effects of unequal vertebral artery(VA) blood flow on the pontine or cerebellar infarcts between the basilar artery(BA) curvature and the vertebrobasilar arteries. Methods Radiological data were analysed(infarct laterality,VA dominance,BA curvature-and their directional relationships) in 91 patients with acute unilateral pontine or posterior inferior cerebellar artery(PICA) territory infarcts.Multiple regression analysis was performed to predict moderate to severe BA curvature.Results The dominant VA was more frequent on the left side (P<0.01).Most patients showed an opposite directional relationship between the dominant VA and BA curvature(P<0.01).Pontine infarcts were opposite to the side of BA curvature(P< 0.01) and PICA infarcts were on the same side as the non-dominant VA side(P<0.01).Compared with control group,it was found that direction of BA curvature,degree of BA curvature,diameter of vertebral arteries were significantly different.The difference in VA diameters was the single independent predictor for moderate to severe BA curvature(OP= 2.70,95%CI:1.22—5.98).Conclusions Unequal VA flow is an important haemodynamic factor for BA curvature,increasing the vertebrobasilar junctional infarcts.