自发性椎动脉及基底动脉夹层相关脑梗死病灶分布特征与受累血管节段间的关系

doi:10.3969/j.issn.1673-5765.2023.10.004

摘要/Abstract

摘要： 目的分析自发性椎动脉夹层（spontaneous vertebral artery dissection，sVAD）、椎-基底动脉夹层（spontaneous vertebral-basilar artery dissection，sV-BAD）及基底动脉夹层（spontaneous basilar artery dissection，sBAD）相关脑梗死病灶分布特征及其与病变血管节段间的关系。
方法本研究为单中心、回顾性研究，连续纳入2015年1月1日—2021年11月15日出院诊断为sVAD、sV-BAD和sBAD相关脑梗死住院患者，收集患者的一般临床资料、既往病史、脑梗死病灶特点、受累血管节段等信息。根据脑梗死病灶数量将患者分为单发脑梗死组和多发脑梗死组，比较两组上述指标的差异。
结果本研究共入组41例患者，其中单发脑梗死组患者17例（41.5%），多发脑梗死组24例（58.5%）。单发脑梗死组与多发脑梗死组不同受累血管节段患者数量对比：V3段[右侧7（41.2%）vs. 8（33.3%），P=0.61；左侧7（41.2%）vs. 7（29.2%），P=0.42]；V4段[右侧9（52.9%）vs. 6（25.0%），P=0.07；左侧6（35.3%）vs. 8（34.8%），P=0.97]，差异均无统计学意义。单发脑梗死组与多发脑梗死组不同脑梗死部位的患者数量对比：丘脑[0（0）vs. 9（39.1%），P=0.005]、枕叶[0（0）vs. 8（33.3%），P=0.01]、小脑[2（11.8%）vs. 20（83.3%），P＜0.001]、脑桥[1（5.9%）vs. 11（45.8%），P=0.006]、延髓[14（82.4%）vs. 3（12.5%），P＜0.001]，单发脑梗死组延髓最多见，其余部位在多发脑梗死组更多见，差异均有统计学意义。单发脑梗死组与多发脑梗死组不同受累血管节段数量的患者例数对比：单一节段7（41.2%）vs. 9（37.5%）、两个节段7（41.2%）vs. 9（37.5%）、多节段3（17.6%）vs. 6（25.0%），差异无统计学意义（P=0.68）。
结论本研究纳入的sVAD、sV-BAD和sBAD相关脑梗死病例中，单发脑梗死病灶多见于延髓，主要受累血管节段为V3段、V4段，脑梗死病灶数量与受累动脉节段数之间的关系尚不明确。

文章导读： 就本队列病例而言，单发脑梗死病灶多见于延髓；受累椎动脉血管节段主要为V3段、V4段，脑梗死病灶数量与受累动脉节段数之间的关系尚不明确。

关键词: 椎动脉夹层; 基底动脉夹层; 脑梗死模式; 病因

Abstract: Objective To investigate the relationship between the distribution characteristics of cerebral infarction and vascular segments in patients with spontaneous vertebral artery dissection (sVAD), spontaneous vertebral-basilar artery dissection (sV-BAD) and spontaneous basilar artery dissection dissection (sBAD).
Methods This was a single-center retrospective study. Hospitalized patients diagnosed with cerebral infarction caused by sVAD, sV-BAD and sBAD from January 1, 2015 to November 15, 2021 were continuously enrolled. General clinical data, past medical history, characteristics of cerebral infarction lesions, and involved vascular segments of patients were collected. The patients were divided into single cerebral infarction group and multiple cerebral infarction group according to the number of cerebral infarction lesions. The differences of the above indexes were compared between the two groups.
Results A total of 41 patients were enrolled in this study, including 17(41.5%) in single cerebral infarction group and 24(58.5%) in multiple cerebral infarction group. Comparison of the main affected vascular segments between single cerebral infarction group and multiple cerebral infarction group: V3 segment[right side 7(41.2%) vs. 8(33.3%), P=0.61; left side 7(41.2%) vs. 7(29.2%), P=0.42]; V4 segment[right side 9(52.9%) vs. 6(25.0%), P=0.07; left side: 6(35.3%) vs. 8(34.8%), P=0.97]. The difference was not statistically significant. Comparison of the location of cerebral infarction between single cerebral infarction group and multiple cerebral infarction group: thalamus [0(0) vs. 9(39.1%), P=0.005], occipital lobe [0(0) vs. 8(33.3%), P=0.01], cerebellum [2(11.8%) vs. 20(83.3%), P<0.001], pons [1(5.9%) vs. 11(45.8%), P=0.006], medulla oblongata [14(82.4%) vs. 3(12.5%), P<0.001]. The medulla oblongata is most commonly seen in single cerebral infarction group, while other parts are more common in multiple cerebral infarction group. There was significant difference between the two groups. The number of involved vascular segments was compared between single cerebral infarction group and multiple cerebral infarction group: single segment 7(41.2%) vs. 9(37.5%), two segments 7(41.2%) vs. 9(37.5%), and multiple segments 3(17.6%) vs. 6(25.0%), with P=0.68, and there was no statistically significant difference.
Conclusions In the cases of sVAD, sV-BAD and sBAD related cerebral infarction included in this study, single cerebral infarction was more common in medulla oblongata. The main involved vascular segments were V3 and V4. The relationship between the number of cerebral infarction lesions and the number of involved artery segments was still not clear.

Key words: Vertebral artery dissection; Basilar artery dissection; Cerebral infarction pattern; Etiology

吴敌, 廖晓凌, 潘岳松, 陈绪珠, 王伊龙, 赵性泉. 自发性椎动脉及基底动脉夹层相关脑梗死病灶分布特征与受累血管节段间的关系[J]. 中国卒中杂志, 2023, 18(10): 1121-1128.

WU Di, LIAO Xiaoling, PAN Yuesong, CHEN Xuzhu, WANG Yilong, ZHAO Xingquan. The Relationship between the Distribution Characteristics of Cerebral Infarction and Involved Vascular Segments in Patients with Spontaneous Vertebral Artery and Basilar Artery Dissection[J]. Chinese Journal of Stroke, 2023, 18(10): 1121-1128.

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