颅内椎动脉夹层与颈动脉夹层病因的对比研究。
A Comparative Study of the Etiology of Intracranial Vertebral Artery Dissection and Carotid Artery Dissection.
机构信息
Department of neurology, Chinese PLA General Hospital.
Department of Interventional vascular surgery, Peking University Third Hospital, Beijing, China.
出版信息
Neurologist. 2023 Sep 1;28(5):281-286. doi: 10.1097/NRL.0000000000000484.
BACKGROUND
Both extrinsic (trauma or violent movement) and intrinsic (structural abnormality, atherosclerosis, or hemodynamic instability) factors may result in arterial dissection. The role of these factors in the origin or progression of dissection remains unclear. This study aimed to characterize the clinical features, radiologic features, and outcomes of intracranial vertebral artery dissection compared with carotid artery dissection and to determine the major causative factors.
METHODS
Consecutive patients with craniocervical dissection (n=127) were retrospectively analyzed. Patients with intracranial vertebral artery dissection (n=77) and those with carotid artery dissection (n=35) were compared with respect to patient age, sex, cerebrovascular risk factors, laboratory indices, and radiologic features.
RESULTS
Intracranial vertebral artery dissection was the most common craniocervical arterial dissection in our cohort (n=77, 60.6%). Body mass index in the intracranial vertebral artery dissection group was significantly greater than that in carotid artery dissection group. Clinical manifestations of intracranial vertebral artery dissection included ischemic stroke (37.7%), dizziness or vertigo (39.0%), and headache or neck pain (44.2%). Two patients had a definite history of trauma. The frontal and lateral tortuosity ratios of the vertebral basilar artery were significantly greater while the vertex angle was smaller in the intracranial vertebral artery dissection group compared with carotid artery dissection group. A positive correlation between the tortuosity ratios and subarachnoid hemorrhage and a significant inverse correlation between the tortuosity ratios and lipid parameters (high-density lipoprotein; apolipoprotein A1) were identified.
CONCLUSIONS
Intrinsic causes may play a more important role in the development of intracranial vertebral artery dissection than carotid artery dissection.
背景
动脉夹层可由外在（创伤或剧烈运动）和内在（结构异常、动脉粥样硬化或血流动力学不稳定）因素引起。这些因素在夹层的起源或进展中的作用仍不清楚。本研究旨在描述与颈内动脉夹层相比，颅内椎动脉夹层的临床特征、影像学特征和结局，并确定主要的致病因素。
方法
回顾性分析连续的颅颈夹层患者（n=127）。比较颅内椎动脉夹层（n=77）和颈内动脉夹层（n=35）患者的年龄、性别、脑血管危险因素、实验室指标和影像学特征。
结果
颅内椎动脉夹层是我们队列中最常见的颅颈动脉夹层（n=77，60.6%）。颅内椎动脉夹层组的体重指数明显大于颈内动脉夹层组。颅内椎动脉夹层的临床表现包括缺血性脑卒中（37.7%）、头晕或眩晕（39.0%）和头痛或颈痛（44.2%）。有 2 例患者有明确的外伤史。与颈内动脉夹层组相比，颅内椎动脉夹层组基底动脉的前后弯曲比明显更大，顶点角度更小。椎动脉的弯曲比与蛛网膜下腔出血呈正相关，与血脂参数（高密度脂蛋白；载脂蛋白 A1）呈显著负相关。
结论
内在原因在颅内椎动脉夹层的发展中可能比颈内动脉夹层更重要。
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