Hsu Chung-Fu, Chen Kuan-Wen, Su Chun-Hung, Shen Chao-Yu, Chi Hsin-Yi
Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan.
Department of Neurology, Chung Shan Medical University, Taichung, Taiwan.
Front Neurol. 2021 Apr 8;12:582149. doi: 10.3389/fneur.2021.582149. eCollection 2021.
Unilateral vertebral artery hypoplasia is considered a risk factor for posterior circulation infarction. Despite the increasing attention on unilateral vertebral artery hypoplasia, few studies have discussed bilateral vertebral artery hypoplasia, its influence on stroke, or its collateral supply from the circle of Willis. We aimed to identify its characteristics, stroke pattern, and unique ultrasonographic and brain imaging findings. Of the 1,301 consecutive in-patients diagnosed with acute ischemic stroke from January 2013 to December 2015, medical and laboratory data and stroke or transient ischemic attack history were recorded. We enrolled patients who underwent both brain magnetic resonance imaging and sonography examinations. Vertebral artery and posterior cerebral artery analyses were conducted in accordance with clinical criteria. Adequate imaging data were available for 467 patients. Of these, eight patients met the criteria for bilateral vertebral artery hypoplasia. The mean age was 62.9 ± 12.1 years. There were six male (75.0%) and two female patients (25.0%). A high prevalence of hypertension (7/8, 87.5%) was noted. Sonograms displayed a very low net flow volume in the vertebral arteries, with the average net flow volume being 28.9 ± 9.7 mL/min. A high frequency (6/8; 75.0%) of the fetal variant posterior cerebral artery from the carotids was found. The infarction patterns in these patients were all bilateral, scattered, and in multiple vascular territories. Patients with bilateral vertebral hypoplasia displayed a unique collateral supply, special stroke pattern, and younger stroke onset. Early recognition and stroke prevention should be considered critical in clinical practice.
单侧椎动脉发育不全被认为是后循环梗死的一个危险因素。尽管对单侧椎动脉发育不全的关注日益增加，但很少有研究讨论双侧椎动脉发育不全、其对中风的影响或来自 Willis 环的侧支供血。我们旨在确定其特征、中风模式以及独特的超声和脑成像表现。在 2013 年 1 月至 2015 年 12 月连续诊断为急性缺血性中风的 1301 例住院患者中，记录了医疗和实验室数据以及中风或短暂性脑缺血发作病史。我们纳入了同时接受脑磁共振成像和超声检查的患者。根据临床标准对椎动脉和大脑后动脉进行分析。467 例患者有足够的成像数据。其中，8 例患者符合双侧椎动脉发育不全的标准。平均年龄为 62.9±12.1 岁。男性 6 例（75.0%），女性 2 例（25.0%）。注意到高血压的患病率很高（7/8，87.5%）。超声图显示椎动脉的净血流量非常低，平均净血流量为 28.9±9.7 mL/分钟。发现来自颈动脉的胎儿型大脑后动脉的频率很高（6/8；75.0%）。这些患者的梗死模式均为双侧、散在且累及多个血管区域。双侧椎动脉发育不全的患者表现出独特的侧支供血、特殊的中风模式和较年轻的中风发病年龄。在临床实践中，早期识别和中风预防应被视为至关重要。
