颈内动脉迂曲增加是自发性颈内动脉夹层的危险因素。
Increased Internal Carotid Artery Tortuosity is a Risk Factor for Spontaneous Cervicocerebral Artery Dissection.
机构信息
The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
The Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
出版信息
Eur J Vasc Endovasc Surg. 2021 Apr;61(4):542-549. doi: 10.1016/j.ejvs.2020.11.046. Epub 2021 Jan 2.
OBJECTIVE
Spontaneous cervicocerebral artery dissection (sCCD) is an important cause of ischaemic stroke that often occurs in young and middle aged patients. The purpose of this study was to investigate the correlation between tortuosity of the carotid artery and sCCD.
METHODS
Patients with confirmed sCCD who underwent computed tomography angiography (CTA) were reviewed retrospectively. Age and sex matched patients having CTA were used as controls. The tortuosity indices of the cervical arteries were measured from the CTA images. The carotid siphon and the extracranial internal carotid artery (ICA) were evaluated according to morphological classification. The carotid siphons were classified into five types. The extracranial ICA was categorised as simple tortuosity, coiling or kinking. Independent risk factors for sCCD were investigated using multivariable analysis.
RESULTS
The study included sixty-six patients with sCCD and 66 controls. There were no differences in vascular risk factors between the two groups. The internal carotid tortuosity index (ICTI) (25.24 ± 12.37 vs. 15.90 ± 8.55, respectively; p < .001) and vertebral tortuosity index (VTI) (median 11.28; interquartile range [IQR] 6.88, 18.80 vs. median 8.38; IQR 6.02, 12.20, respectively; p = .008) were higher in the patients with sCCD than in the controls. Type III and Type IV carotid siphons were more common in the patients with sCCD (p = .001 and p < .001, respectively). The prevalence of any vessel tortuosity, coiling and kinking of the extracranial ICA was higher in the patients with sCCD (p < .001, p = .018 and p = .006, respectively). ICTI (odds ratio [OR] 2.964; p = .026), VTI (OR 5.141; p = .009), and Type III carotid siphons (OR 4.654; p = .003) were independently associated with the risk of sCCD.
CONCLUSION
Arterial tortuosity is associated with sCCD, and greater tortuosity of the cervical artery may indicate an increased risk of arterial dissection.
目的
自发性颈内动脉夹层（sCCD）是中青年缺血性脑卒中的重要病因，常发生于中青年。本研究旨在探讨颈内动脉迂曲与 sCCD 的相关性。
方法
回顾性分析经计算机断层血管造影（CTA）检查确诊为 sCCD 的患者。以年龄和性别匹配的 CTA 患者作为对照。从 CTA 图像中测量颈内动脉迂曲指数。根据形态学分类评估颈动脉虹吸段和颅外颈内动脉（ICA）。颈动脉虹吸段分为五型。颅外 ICA 分为单纯迂曲、卷曲或扭曲。采用多变量分析探讨 sCCD 的独立危险因素。
结果
本研究纳入 66 例 sCCD 患者和 66 例对照。两组患者血管危险因素无差异。颈内动脉迂曲指数（ICTI）（25.24±12.37 比 15.90±8.55，p<0.001）和椎动脉迂曲指数（VTI）（中位数 11.28；四分位距 [IQR] 6.88，18.80 比中位数 8.38；IQR 6.02，12.20，p=0.008）在 sCCD 患者中更高。sCCD 患者的 III 型和 IV 型颈动脉虹吸段更常见（p=0.001 和 p<0.001）。sCCD 患者任何血管迂曲、卷曲和扭曲的发生率更高（p<0.001、p=0.018 和 p=0.006）。ICTI（比值比 [OR] 2.964；p=0.026）、VTI（OR 5.141；p=0.009）和 III 型颈动脉虹吸段（OR 4.654；p=0.003）与 sCCD 风险独立相关。
结论
动脉迂曲与 sCCD 相关，颈内动脉迂曲程度增加可能提示动脉夹层风险增加。
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