Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan.
Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan.
J Stroke Cerebrovasc Dis. 2020 Apr;29(4):104636. doi: 10.1016/j.jstrokecerebrovasdis.2020.104636. Epub 2020 Jan 31.
Intracranial arterial dissection is a major cause of ischemic stroke and subarachnoid hemorrhage in relatively young patients. We assessed the hypothesis that the tortuosity of the vertebrobasilar artery is associated with the occurrence of vertebral artery (VA) dissection, using MR angiography (MRA).
This study enrolled 43 patients with VA dissection, and 63 age- and sex-matched healthy subjects were used as the controls. MRA was employed to evaluate the presence of dominant VA and the lateral shift of vertebrobasilar junction in both groups. The VA diameters were considered different when the difference was greater than .3 mm. These anatomical variations were divided into 3 types: Type 1 (vertebrobasilar junction within 2 mm from the midline), Type 2 (>2 mm-lateral shift of vertebrobasilar junction to the ipsilateral side of the dominant VA), and Type 3 (>2 mm-lateral shift of vertebrobasilar junction to the contralateral side of the dominant VA).
The presence of dominant VA and the lateral shift of vertebrobasilar junction were more prevalent in patients with VA dissection than in the controls (OR: 3.46, P = .013, and OR: 4.51, P = .001, respectively). The lateral shift of vertebrobasilar junction was classified into Type 1 (n = 6), Type 2 (n = 13), and Type 3 (n = 17) among patients with VA dissection, while into Type 1 (n = 20), Type 2 (n = 8), and Type 3 (n = 7) among the controls. Type 3 predominance was observed in patients with VA dissection (P = .02).
Anatomical variations of the vertebrobasilar artery may play an important role in the occurrence of VA dissection.
颅内动脉夹层是年轻患者发生缺血性卒中和蛛网膜下腔出血的主要原因。我们通过磁共振血管造影（MRA）评估了椎动脉（VA）夹层与椎基底动脉迂曲之间存在关联的假设。
本研究纳入了 43 例 VA 夹层患者，并选择了 63 名年龄和性别相匹配的健康对照者作为对照组。在两组患者中，均采用 MRA 评估优势 VA 的存在和椎基底动脉交界的外侧移位。当差异大于 0.3mm 时，认为 VA 直径不同。将这些解剖学变异分为 3 种类型：1 型（椎基底动脉交界位于中线 2mm 内）、2 型（椎基底动脉交界向优势 VA 的同侧侧方移位>2mm）和 3 型（椎基底动脉交界向优势 VA 的对侧侧方移位>2mm）。
与对照组相比，VA 夹层患者中优势 VA 的存在和椎基底动脉交界的外侧移位更为常见（OR：3.46，P=0.013 和 OR：4.51，P=0.001）。VA 夹层患者的椎基底动脉交界外侧移位分为 1 型（n=6）、2 型（n=13）和 3 型（n=17），而对照组则分为 1 型（n=20）、2 型（n=8）和 3 型（n=7）。在 VA 夹层患者中观察到 3 型占优势（P=0.02）。
椎基底动脉的解剖学变异可能在 VA 夹层的发生中起重要作用。
