Abstract：【Objective】To explore the correlation between the severe stenosis or occlusion of unilateral vertebral artery (VA) and the symptoms of posterior circulation ischemia. 【Methods】The clinical data of 177 patients with unilateral VA severe stenosis or occlusion admitted to our hospital were analyzed retrospectively. All patients underwent magnetic resonance imaging (MRI),digital subtraction angiography (DSA) and carotid artery ultrasound (CDU) after admission;The site of VA severe stenosis or occlusion,the condition of VA severe stenosis and occlusion,whether the patients with unilateral VA severe stenosis or occlusion had symptoms of posterior circulation ischemia,and hemodynamic parameters [peak systolic blood flow velocity (PSV),end-diastolic blood flow velocity (EDV),vascular resistance index (RI),and vertebral artery diameter (VAD)] were evaluated. The differences of hemodynamic parameters in patients with unilateral VA severe stenosis or occlusion in the initial segment,extracranial segment and intracranial segment were compared,and the occurrence of posterior circulation ischemia symptoms in patients with different VA severe stenosis or occlusion was observed. 【Results】All 177 patients completed MRI and DSA examination. The DSA examination showed that 62.71% of VA severe stenosis and 37.29% of VA mild stenosis; In MRI examination,54.24% of VA initial segment severe stenosis or occlusion,16.95% of extracranial segment severe stenosis or occlusion,28.81% of intracranial segment severe stenosis or occlusion,83.33% of initial segment severe stenosis or occlusion moderate and severe stenosis,16.67% of occlusion,46.67% of extracranial segment severe stenosis or occlusion moderate and severe stenosis,53.33% of occlusion,33.33% of intracranial segment severe stenosis or occlusion moderate and severe stenosis,66.67% of occlusion. In MRI examination,48.02% (85/177) had symptoms of posterior circulation ischemia,and 51.98% (92/177) had no symptoms of posterior circulation ischemia. PSV,EDV,RI and VAD of the affected side of patients with severe VA stenosis or occlusion at the initial segment were lower than those of the healthy side (P<0.05). The PSV and EDV of the patients with severe VA stenosis or occlusion in the extracranial segment were higher than those of the healthy side,and the VAD of the affected side was lower than that of the healthy side,the difference was statistically significant (both P<0.05); There was no significant difference in RI between the affected side and the healthy side of patients with severe VA stenosis or occlusion in extracranial segment (P>0.05). PSV,EDV and VAD of the patients with severe intracranial VA stenosis or occlusion were lower than those of the healthy side,and RI was higher than that of the healthy side (P<0.05). The incidence of posterior circulation ischemia symptoms (transient cerebral ischemia,cerebral infarction) in patients with severe VA stenosis or occlusion in extracranial segment and initial segment was higher than that in initial segment (P<0.05). 【Conclusion】 There is a certain relationship between the occurrence of posterior circulation ischemia symptoms and the location of severe VA stenosis or occlusion. Timely imaging examination of patients with unilateral VA severe stenosis or occlusion before treatment can provide help for the treatment and prognosis evaluation of the disease.
陈利, 雷波, 吴嘉川, 郑念东. 单侧VA重度狭窄或闭塞部位与后循环缺血症状的相关性分析[J]. 医学临床研究, 2023, 40(2): 191-194.
CHEN Li, LEI Bo, WU Jia-chuan,et al. Correlation between Severe Stenosis or Occlusion of Unilateral VA and Symptoms of Posterior Circulation Ischemia. JOURNAL OF CLINICAL RESEARCH, 2023, 40(2): 191-194.
[1] 张晓,杨伊姝,刘占东. 脑动脉夹层所致急性脑梗死/短暂性脑缺血发作患者的临床及影像学特征研究[J].实用心脑肺血管病杂志,2018,26(9):33-37.
[2] SAVITZ S I,CAPLAN L R. Vertebrobasilar disease[J].New Engl J Med,2005,352(25):2618-2626.
[3] SEARLS ED,PAZDERA L ,KORBEL E ,et al. Symptoms and signs of posterior circulation ischemia in the new England medical center posterior circulation registry[J].Arch neurol,2012,69(3):346-351.
[4] 华扬,惠品晶,邢瑛琦. 中国脑卒中血管超声检查指导规范[J].中华医学超声杂志(电子版),2015,12(8):599-610.
[5] 白雪,张晶晶. 椎动脉颅内近远段粥样硬化狭窄患者的后循环缺血梗死区域、临床症状及伴发脑动脉狭窄对比分析[J].山东医药,2016,56(43):60-62.
[6] 张晶晶,白雪.颅内段与颅外段双侧椎动脉狭窄临床特征差异分析[J].山东医药,2016,56(21):72-73.
[7] 沈佩婷,温晓红. 早产儿脑白质损伤MRI及振幅整合脑电图诊断与预后评价的研究进展[J].中国妇幼保健,2020,35(23):4642-4644.
[8] 周思超. 颅脑CT血管成像对急性缺血性脑卒中患者诊断及预后判断的价值[J].中国CT和MRI杂志,2022,20(1):28-31.
[9] 崔凤,袁杭,乐先杰,等. 颅外颈部动脉狭窄发生率的磁共振血管成像评价[J].中国动脉硬化杂志,2006,14(12):1061-1064.
[10] 杨洁,华扬,李秋萍,等. 血管超声评估永存颈内动脉-椎基底动脉吻合的血流动力学特征[J].中国脑血管病杂志,2019,16(9):471-477.
[11] 张莹,刘红英,徐洁,等. 超声对椎动脉颅外段与颅内段闭塞患者的血流动力学评价[J].实用医学杂志,2018,34(22):3792-3795.
[12] 丁亚芳,惠品晶,胡春洪,等. 椎动脉重度狭窄或闭塞部位与后循环缺血的相关性研究[J].海南医学院学报,2019,25(21):1621-1627.
2023, Vol. 40 
