Department of Anatomy, Showa University Graduate School of Medicine, Tokyo, Japan.
Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
J Stroke Cerebrovasc Dis. 2020 Jul;29(7):104852. doi: 10.1016/j.jstrokecerebrovasdis.2020.104852. Epub 2020 May 11.
Branch atheromatous disease is an ischemic stroke, involving occlusion or severe stenosis of the perforating artery, causing neurologic symptoms and serious sequelae. We aimed to investigate initial morphometric and hemodynamic characteristics of the vertebral artery immediately post-onset to predict lesion expanding.
This case-control study collected demographic, historical, and physical examination data from 44 patients with branch atheromatous disease in the pons at admission. The maximum ischemic pons area and stenosis rate in the basilar artery were calculated using magnetic resonance images. Diameter, velocity, and flow volume of the vertebral arteries were measured using carotid artery ultrasonography. Correlations between ischemic lesion extent and these parameters were investigated.
Patients were assigned to groups of less (Group 1) or more (Group 2) than the median maximum ischemic area in the pons, calculated from magnetic resonance images (121.6 mm). Modified Rankin scale scores were significantly worse in Group 2. Blood pressure and blood findings were similar between groups. Group 2 showed significantly higher basilar artery stenosis rates. Flow volume, velocity, peak systolic velocity, and end-diastolic velocity in the vertebral artery on both sides were significantly decreased in Group 2.
Deteriorated vertebral artery hemodynamics caused a more extensive ischemic lesion in branch atheromatous disease in the pons. Evaluation of the vertebral using carotid artery ultrasonography in the acute phase may be useful for predicting disease progression.
分支粥样硬化性疾病是一种缺血性脑卒中，涉及穿支动脉闭塞或严重狭窄，导致神经功能症状和严重后遗症。我们旨在探讨椎动脉发病即刻的初始形态和血流动力学特征，以预测病变进展。
本病例对照研究纳入了 44 例发病时桥脑分支粥样硬化性疾病患者的人口统计学、病史和体格检查数据。采用磁共振成像计算基底动脉最大缺血性脑桥面积和狭窄率。采用颈动脉超声测量椎动脉直径、速度和流量。探讨了缺血性病变范围与这些参数之间的相关性。
根据磁共振成像计算的脑桥最大缺血面积（121.6mm）中位数，将患者分为面积较小（1 组）或较大（2 组）的组。2 组患者的改良 Rankin 量表评分显著较差。组间血压和血液检查结果相似。2 组患者的基底动脉狭窄率显著较高。2 组患者双侧椎动脉流量、速度、收缩期峰值速度和舒张末期速度均显著降低。
椎动脉血流动力学恶化导致桥脑分支粥样硬化性疾病的缺血性病变范围更广。在急性期使用颈动脉超声评估椎动脉可能有助于预测疾病进展。
