背景:颅内动脉粥样硬化是后循环卒中和短暂性脑缺血发作(TIA)的主要原因之一,特别是在南亚和东亚的遗产。局灶性血管几何形状可能在动脉粥样硬化进展中起作用。因此,我们调查了椎基底动脉(VBA)几何形状和椎基底动脉粥样硬化性狭窄的相关性,复发,后循环中风和TIA死亡。
方法:纳入四百二十例后循环缺血性卒中或TIA患者。VBA几何特征,包括几何配置(音叉,散步,拉姆达,并且没有汇合),血管弯曲(多弯曲和寡弯曲),和VBA狭窄程度,是根据计算机断层扫描血管造影(CTA)图像定义的。通过1年随访评估卒中或TIA复发和死亡。此外,VBA几何特征之间的关系,VBA狭窄,并对预后进行分析。
结果:步行型和血管多弯曲与更严重的VBA狭窄和分布显着相关,这些在大动脉粥样硬化(LAA)卒中患者中也更常见(均P<0.05)。64例患者出现复发性卒中或TIA,31人在1年随访期间死亡。在二元逻辑回归分析中,步行型(P=0.018),λ型(P=0.021),发现多弯曲类型(P=0.004)与卒中复发独立相关,而无融合类型与死亡独立相关(P=0.010)。
结论:VBA的几何特征与椎基底动脉狭窄有关,左心耳冲程,1年复发,后循环中风和TIA死亡。VBA几何形状可用于对后循环中的中风和TIA的风险进行分层。
BACKGROUND: Intracranial atherosclerosis is one of the primary causes of posterior circulation stroke and transient ischemic attack (TIA), particularly in people of South and East Asian heritage. Focal vessel geometry may play a role in atherosclerosis progression. Thus, we investigated the relevance of vertebrobasilar artery (VBA) geometry and vertebrobasilar atherosclerotic stenosis, recurrence, and death in posterior circulation stroke and TIA.
METHODS: Four hundred and twenty patients with posterior circulation ischemic stroke or TIA were included. The VBA geometric features, comprising the geometric configurations (Tuning fork, Walking, Lambda, and No confluence), vascular bends (multi-bending and oligo-bending), and VBA stenosis degrees, were defined based on computed tomography angiography (CTA) images. Recurrence of stroke or TIA and death were assessed through a 1-year follow-up. Additionally, the relationship between VBA geometric features, VBA stenosis, and prognosis were analyzed.
RESULTS: Walking type and vascular multi-bending showed significant associations with more severe VBA stenosis and distribution, and these were also more frequently observed in patients with large-artery atherosclerosis (LAA) stroke (all P < 0.05). Sixty-four patients exhibited recurrent stroke or TIA, and 31 died during the 1-year follow-up. In the binary logistic regression analysis, Walking type (P = 0.018), Lambda type (P = 0.021), and multi-bending type (P = 0.004) were found to be independently associated with stroke recurrence, while No confluence type was independently associated with death (P = 0.010).
CONCLUSIONS: The geometric characteristics of the VBA are associated with vertebrobasilar stenosis, LAA stroke, 1-year recurrence, and death in posterior circulation stroke and TIA. VBA geometry may be used to stratify the risk of stroke and TIA in the posterior circulation.