后循环缺血与前循环卒中患者单侧椎动脉优势现象对比

摘要

目的 探讨单侧椎动脉优势现象在后循环缺血(posterior circulation ischemia,PO)发病中的意义.方法 通过全脑数字减影血管造影(digital subtraction angiography,DSA),对比检测120例PCI及96例前循环卒中患者(对照组)中一侧椎动脉发育不良及椎动脉优势现象的分布差异,分析椎动脉优势或发育不良与PCI的相互关联,及其优势比(odds ratio,OR)和相对危险度(relative risk,RR).结果 PCI组椎动脉优势与椎动脉发育不良的患者分别为63例(52.5％)和11例(9.17％),对照组分别为30例(31.25％)和2例(2.08％),PCI组病例椎动脉优势及椎动脉发育不良出现率均明显高于对照组(分别为x2=9.823,P＝0.002及x2=4.731,P=0.030),且PCI组有椎动脉优势或发育不良的危险较对照组明显增高(OR 2.432,95％ CI 1.388 ～ 4.261;OR＝4.743,95％ CI 1.025～21.942),而有一侧椎动脉优势或发育不良的患者出现PCI的危险明显高于没有该血管变异的病例(RR 1.462,95％ CI 1.154 ～ 1.185,RR 1.576,95％ CI 1.209 ～ 2.053).结论 椎动脉发育不良及椎动脉优势现象与PCI间存在明显关联,单侧椎动脉优势这种常见的血管变异现象在PCI发病中可能有重要意义.%Objectives To explore the role of lateral vertebral artery (VA) dominance in patients with posterior circulation ischemia (PCI). Methods Lateral VA dominance and VA hypoplasia were detected by digital subtraction angiography (DSA) in 120 consecutive patients with PCI and 96 cases with anterior circulation stroke (control group). Hie association of VA dominance or VA hypoplasia with PCI was analyzed. Results Lateral VA dominance and VA hypoplasia were found in 63 (52.5%) and 11 (9.17%) patients with PCI, and 30 (31.25%) and 2 (2.08%) controls, respectively. The dominant VA and hypoplastic VA were more frequent in PCI group than in controls (X2 = 9.823, P = 0.002; X2 = 4.731, P = 0.030, respectively). The risk of lateral VA dominance or hypoplasia were much higher in PCI group than in control group (OR 2.432, 95% CI 1.388 - 4.261; OR 4.743, 95% CI 1.025 - 21.942), and patients with lateral VA dominance or hypoplasia had a significantly higher risk of PCI than those without (RR 1.462, 95% CI 1.154 - 1.185; RR 1.576, 95% CI 1.209 - 2.053). Conclusions There are significant correlations between lateral VA dominance or hypoplasia and PCI and these congenital variants of VA may contribute to the posterior circulation ischemia.