Vertebrobasilar Dolichoectasia Imaging Features And Relationship With Posterior Circulation Ischemia

Objective: vertebrobasilar dolichoectasia(VBD) is a kind of cerebrovascular disease characterized by significantly prolonged, twisted or angled of the vertebral- basilar artery.The prevalence is relatively low. But recent years stroke patients with VBD often reported. Although the incidence of overall population is low, it’s not uncommon in stroke patients. The risk of recurrent stroke and annual mortality also high in stroke with VBD patients. VBD is drawing more attention of people. We aim to improve the knowledge of ischemic cerebrovascular disease with VBD, by evaluating the features of clinical manifestations, and imaging features in stroke patients with VBD.Methods: We consecutively collected 90 patients with cerebral infarction from the neurology department of the 2nd Hospital affiliated to Hebei Medical University(admission from June 2014 to October 2014). All of the 100 cases were eligible for the diagnostic criteria revised in the Fourth National Cerebrovascular Disease Conference in 1995 and were confirmed by computerized tomography(CT) or magnetic resonance imaging(MRI).All were admitted within 7 days(age, 28-82 years; mean age, 60.99±11.49 years).Patients with blood disease, atrial fibrillation, malignant tumor, liver and renal insufficiency or heart failure were excluded. The patients were divided into case group(VBD group,40 cases) and control group(non VBD group,50 cases) according to if they had VBD through image manifestations. The diagnosis of VBD is based on the criteria raised by Smoker, Giang and Ubogu.We collected the general data(gender, age, history of other diseases, smoking, alcohol intake), biochemical parameters(plasma-lipoids, Homocysteine), the severity of neurological deficit(assessed by the National Institutes of Health Stroke Scale, NIHSS), posterior circulation TIA, the lesion location, imaging features and curative efficiency. We used SPSS 13.0 statistical analysis software. The measurement data were analyzed by Two-sample t-test, while the numeration data were analyzed by chi-square test, P<0.05 as had statistical significance.Results: 1 General parameters 1.1Sex and ageIn the case group, 30 cases(75%) were male, the average age was 61.45±11.74; In the control group, 35 cases(70%) were male, the average age was 60.62±11.39. There was no statistical difference between two groups(P>0.05) 1.2History of other risk factorsThere was no significant difference in hypertension, diabetic, coronary disease,strok history, posterior circulation TIA, smoking history, and alcohol intake between the two groups(P>0.05).2 Comparison of biochemical parametersIn the VBD group, 29 cases(72.5%) had hyperhomocysteinemia while 19 cases(38%) in the non VBD group, the incidence of hyperhomocysteinemia was significantly higher than in the non VBD group(P=0.01). However there was no significant difference in hyperlipidemia between the two groups(P>0.05). 3 Clinical characteristics 3.1 The severity of neurological deficitIn the case group, there were 33 cases(82.5%) with mild neurological deficit and 7 cases(17.5%)with moderate neurological deficit, while there were 43 cases(86%) with mild neurological deficit and 7 cases(14%)with moderate neurological deficit. Both had no severe neurological deficit cases. There was no statistical difference between the two groups in the severity of neurological deficit(P>0.05). 3.2 The improvement of neurological deficitCompare the total efficiency between the case group and control group. The total efficiency of the case group was 15%, and the total efficiency of the control group was 38%. There was statistical difference between the two groups(P<0.05). 3.3 The improvement of clinical symptomsIn the case group, clinical symptoms were completely improved in 9 cases, clinical symptoms were improved a little in 24 cases, no significant changes of symptoms in 7 cases; in the control group, clinical symptoms were completely improved in 31 cases, clinical symptoms were improved a little in 17 cases, no significant changes of symptoms in 2 cases, and there was no aggravated cases in two groups. The curative efficiency of stroke patients with VBD was poorer than the non VBD patients. There was statistical difference between the two groups(P<0.001). 4 Imaging feature 4.1 Lesion locationIn the case group, there were 18 cases(45%) with anterior circulation infarcts and 22(55%) cases with posterior circulation infarcts, of which 16 cases located in brainstem(pons 3cases, medulla 2cases, mesencephalon 1case), 3 cases in cerebellum, 2cases in occipital, 1case in temporal lobe. In the control group, there were 36 cases(72%) with anterior circulation infarcts and 14(28%) cases with posterior circulation infarcts. There was statistical difference between the two groups in the lesion location(P>0.05). VBD increase the risk of posterior circulation ischemia. 4.2 Distortion of the carotid artery systemIn the VBD group, distortion of the carotid artery system was observed in 16 cases, while 9 cases in the control group. There was statistical difference between the two groups(P<0.05). VBD probably is a part of dolichoectasiaof intracranial arteries.Conclusions:1 VBD group has no difference in age, sex ratio, blood pressure, lipid level, diabetic, posterior circulation TIA, strok history alcohol intake and the severity of neurological deficit,compared with the non VBD group.2 VBD patients, compared with those without VBD, had a higher incidence of posterior circulation ischemia.So VBD is a risk factor of posteriorcirculation ischemia.3 The curative efficiency of stroke patients with VBD was poorer than the non VBD patients.4 Compared with non VBD group, VBD group had a higher incidence of distortion of the carotid artery system, VBD probably is a part of dolichoectasia of intracranial arteries.5 In the VBD group, the incidence of hyperhomocysteinemia was significantly higher than in the non VBD group,hyperhomocysteinemia may be a related risk factor of VBD.