Zhou Li, Yan Yufeng, Du Heng, Ni Xiaoxing, Wang Guodong, Wang Qiaoshu
Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Medicine (Baltimore). 2020 May;99(18):e19742. doi: 10.1097/MD.0000000000019742.
Hemodynamic changes occurring at the segments of arterial bifurcations, up and down stream of stenotic vessels appear to play a critical role in the development of atherosclerosis. Therefore, we hypothesized that basilar artery (BA) geometry may be related to the distribution of atherosclerotic plaque.In this retrospective cross-sectional study, all patients hospitalized with ischemic stroke and intracranial atherosclerotic disease were sifted from March 2017 to October 2017. Sixty-seven patients with intracranial atherosclerotic disease (39 with and 28 without BA atherosclerosis) were analyzed. Magnetic resonance imaging, magnetic resonance angiography, and high-resolution black-blood MRI were performed within 7 days after symptoms onset. BA tortuosity, plaque location, and plaque enhancement were assessed. Plaque burden and vascular remodeling were measured.Of the 39 patients with BA atherosclerosis, plaques preferred to be formed at the inner arc than the outer arc (27/39, 69% vs 12/39, 31%) in the tortuous BA. In addition, patients with BA plaque had a greater vascular tortuosity compared with those without plaque (113.1 ± 10.2 vs 107 ± 4.6; P = .034). Finally, patients with apparent BA plaque had greater plaque enhancement (14/21, 67% vs 5/18, 28%; P = .017) and plaque burden (0.76 ± 0.15 vs 0.70 ± 0.09; P = .036) compared with those with minimal plaque.Plaque may be more likely to form at the inner arc of tortuous BA with atherosclerotic disease, and increased BA tortuosity is associated with its likelihood to form plaque.
动脉分叉段、狭窄血管上下游发生的血流动力学变化似乎在动脉粥样硬化的发展中起关键作用。因此，我们推测基底动脉（BA）的几何形状可能与动脉粥样硬化斑块的分布有关。在这项回顾性横断面研究中，我们筛选了2017年3月至2017年10月期间因缺血性卒中和颅内动脉粥样硬化疾病住院的所有患者。分析了67例颅内动脉粥样硬化疾病患者（39例有BA动脉粥样硬化，28例无BA动脉粥样硬化）。在症状发作后7天内进行了磁共振成像、磁共振血管造影和高分辨率黑血MRI检查。评估了BA的迂曲度、斑块位置和斑块强化情况。测量了斑块负荷和血管重塑情况。在39例有BA动脉粥样硬化的患者中，在迂曲的BA中，斑块更倾向于在内侧弧而非外侧弧形成（27/39，69%对12/39，31%）。此外，与无斑块患者相比，有BA斑块的患者血管迂曲度更大（113.1±10.2对107±4.6；P=0.034）。最后，与斑块最小的患者相比，有明显BA斑块的患者斑块强化程度更高（14/21，67%对5/18，28%；P=0.017），斑块负荷也更大（0.76±0.15对0.70±0.09；P=0.036）。在患有动脉粥样硬化疾病的迂曲BA内侧弧，斑块可能更易形成，且BA迂曲度增加与其形成斑块的可能性相关。
