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椎动脉优势和基底动脉弯曲与后循环梗死部位的关系
朱伟冯红选董晓峰刘春风
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摘要:
目的 探讨椎动脉优势、基底动脉弯曲与后循环梗死的关系,分析后循环不同部位梗死患 者的椎动脉优势与基底动脉弯曲的关系。方法 选取临床表现为后循环梗死、头晕和眩晕、头痛等症状 患者156例,根据MRA检查结果分成椎动脉优势组(86例)及非优势组(70例)。比较两组间后循环各部位 的梗死发生率以及基底动脉弯曲的发生率,分析优势组各梗死部位后循环梗死侧与椎动脉优势侧的关 系,基底动脉弯曲方向与椎动脉优势侧相关性,基底动脉弯曲与后循环梗死的相关性。结果 85.1%(40/47) 基底动脉弯曲向椎动脉优势对侧,基底动脉弯曲方向与椎动脉优势方向呈负相关(r=-0.704,P < 0.01),优 势组后循环梗死的发生率明显高于对照组[51.2%( 44/86) 比22.9%( 16/70),χ2=13.063,P<0.01]。两组 间在小脑后下动脉(PICA)区和基底动脉(BA)区梗死发生率差异均有统计学意义,其余部位两组间的发 生率差异无统计学意义。基底动脉弯曲患者在PICA区和BA区梗死发生率与基底动脉呈直线患者差异 均有统计学意义,其余部位梗死的发生率差异无统计学意义。结论 椎动脉优势易于导致基底动脉弯曲 的发生,基底动脉易向优势对侧发生弯曲。椎动脉优势容易发生PICA供血区及BA脑桥支供血区的梗死, PICA供血区梗死部位多发生在椎动脉优势对侧,基底动脉弯曲侧;而BA脑桥支供血区的梗死多发生在 椎动脉优势侧,即基底动脉弯曲的对侧。
关键词:  椎动脉优势  后循环梗死  基底动脉弯曲  核磁共振血管成像
DOI:10.3969/j.issn.1009-6574.2017.10.003
基金项目:苏州市科技发展计划项目(SYSD2016114)
Correlation of vertebral artery dominance and basilar artery curvature with the territory of posteriorcirculation infarction
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Abstract:
Objective To investigate the correlation of vertebral artery dominance(VAD) and basilar artery( BA) curvature with posterior circulation infarction( PCI), and to analyze the relationship between VAD of patients with different infarction of the posterior circulation and BA curvature. Methods According to magnetic resonance angiography( MRA) and the diagnostic criteria of VAD, a total of 156 patients with PCI, dizziness and headache were selected and divided into VAD group( n=86) and non-VAD group( n=70). The incidence of separate territory infarction in posterior circulation and the incidence of BA curvature were compared between the two groups. The relationship between the laterality of posterior infarction and the laterality of VAD of the infarction area in the VAD group was analyzed.It also discussed the correlation of BA curvature with laterality of VAD and PCI. Results A total of 85.1%( 40/47) patients had an opposite directional relationship between dominant VA and BA curvature, and the direction of BA curvature and VAD was negatively correlated( r=-0.704, P<0.01). The total incidence of PCI in VAD group was significantly higher than that in non-VAD group[ 51.2% (44/86) vs. 22.9%( 16/70),χ2=13.063,P<0.01]. The incidences of infarctions in posterior inferior cerebellar artery( PICA) territory and BA territory were both statistically higher than that in controls, however, there was no difference in superior cerebellar artery( SCA) and posterior cerebral artery( PCA) territory infarction between the two groups. The incidence of PCI in BA curvature patients was significantly higher than that in BA straight patients with statistical difference, and the difference of infarction incidence in residual territories was not significant. Conclusions The incidence of BA curvature is higher in VAD patients, and BA usually bends to the opposite side of dominant VA. The incidence of PCI is higher in VAD patients, especially in PICA infarction and BA infarction patients. Most PICA infarctions occurred on the opposite side of dominant VA and the laterality of BA curvature, while the BA pontine branch territory infarction were on the side of dominant VA, which is the opposite side of BA curvature.
Key words:  Vertebral artery dominance  Posterior circulation infarction  Basilar artery curvature  Magnetic resonance angiography

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