Study On The Correlation Between Posterior Circulation Infarction And Vertebral Artery Dysplasia

Background:At present,with the increase in the detection rate of vertebral artery hypoplasia(VAH),the research on VAH and related diseases is gradually increasing,and it is no longer a meaningless and pure physiological variation as previously thought.Stroke is a major killer that harms humankind worldwide,and it has brought huge losses to human economic and spiritual life.Posterior circulation infarction(PCI),as a type of ischemic stroke,has a significantly higher disability and fatality rate than other parts,with severe clinical symptoms and poor prognosis.Research on the relationship between VAH and PCI is incrasing,scholars continue to conduct research on VAH and PCI and explored the correlation between the two,they believe that VAH can be used as a risk factor for PCI alone,there are also related scholars who disagree with this view.But the research on the related mechanism between the two is still inaccurate.Objective:There is currently no unified standard for the definition and incidence of VAH.This study uses relevant clinical data to explore the incidence of VAH in a specific range,the distribution and precipitating factors of VAH to PCI,and the possible mechanisms involved.And provide a certain reference for clinical medical workers in the diagnosis and treatment of such diseases,and can improve the level of treatment as much as possible in the early stage.Methods:A retrospective analysis was used to enroll 165 patients who were hospitalized in The First Affiliated Hospital of Henan University from January 2018 to December 2020 and were confirmed to have acute posterior circulatory infarction.All admitted patients meet the definition of acute cerebral infarction in the American stroke association acute ischemic stroke management guidelines.All patients underwent 3.0T cranial magnetic resonance and cervical vascular color doppler ultrasound within 24 hours of admission.After admission,blood was drawn from the abdomen on the second day,collect general admission information(gender,age,hypertension,diabetes,coronary heart disease,smoking history,creatinine(Cr),urea nitrogen(BUN),low-density lipoprotein(LDL-C),high-density lipoprotein(HDL-C)),imaging data,acute cerebral infarction patients were given National Institute of Health stroke scale score and TOAST classification within 24 hours of admission and TOAST classification was performed according to the cause of the cerebral infarction.The definition of VAH is based on the study of Thierfelder et al,use craniovascular magnetic resonance,the vertebral artery diameter is less than 2mm or the bilateral vertebral artery diameter ratio is less than 1:1.7,165 patients with posterior circulatory infarction are divided into VAH group and non-VAH group according to whether they are accompanied by VAH.At least two doctors were used to determine whether the fetal origin of the posterior cerebral artery(FTP)was complicated by brain vascular magnetic resonance.All statistical data were analyzed by SPSS24.0 software.Chi-square test was used for count data,t test was used for measurement data that conformed to normal distribution,and nonparametric test was used for data that did not conform to normal distribution.The results of univariate analysis between the two groups were analyzed by Logistic regression for parameters with P<0.05.P<0.05 the difference is considered to be statistically significant.Results:1.Among the 165 patients with posterior circulation infarction,60 patients in the VAH group,accounting for 36.4%,and 105 patients in the non-VAH group,accounting for 63.6%.In Table 1,the general admission information of the two groups of patients(gender,age,hypertension,diabetes,coronary heart disease,smoking history),biochemical indicators(Cr、BUN、LDL-C、HDL-C),TOAST classification,NIHSS score were compared,and there was no significant difference between the two groups(P>0.05).2.The distribution of the infarct lesions in the VAH group and the non-VAH group was compared.The infarct location was divided into three areas: the medulla oblongata and the posterior inferior cerebellar artery blood supply area,the pons and the anterior inferior cerebellar artery blood supply area,the midbrain,thalamus,and occiput,occipital lobe or temporal lobe blood supply area,the two groups of patients in the medulla oblongata and posterior inferior artery blood supply area(P=0.474),midbrain,thalamus,occipital lobe or temporal lobe(P=0.101),there was no significant difference.The VAH group(38.33%)and the non-VAH group(55.24%)had statistical significance in the blood supply area of the pons and the anterior inferior cerebellar artery(P=0.037).3.15 patients In the VAH group with FTP and 12 patients in the non-VAH group with FTP.The comparison between the two groups was statistically significant(P=0.023).In the VAH group,there were53 cases(88.3%)of VAD patients,and 72 cases(68.6%)in the non-VAH group.The comparison between the two groups was statistically significant(P=0.004).In the VAH group,37 cases were left VAD and 16 cases were right VAD.In the non-VAH patient group,49 cases were left VAD and 23 cases were right VAD.The difference in VAD between the two groups was not statistically significant(P=0.834).4.Multivariate logistic regression analysis showed that compared with the non-VAH group,the probability of infarction in the pons and anterior cerebellar artery blood supply area in the VAH group was lower than that in the non-VAH group(OR=2.023,95%CI: 1.030-3.971,P=0.041),the probability of combining VAH with FTP(OR=0.389,95%CI: 0.163-0.931,P=0.034)and VAD(OR=0.293,95%CI:0.118-0.727,P=0.008)was higher than that of non-VAH group.5.In the group of patients with PCI and VAH,the proportion of male patients(70%)was higher than that of female patients(30%).17 patients(28.33%)were located on the left and 40 patients(66.67%)were located on the right,there were 3 cases(5%)with dysplasia of bilateral vertebral arteries.The incidence of right VAH was higher than that of left VAH and bilateral VAH.Among the 17 patients with left VAH,the posterior circulation infarction was located on the left were 11 cases(64.71%),4 cases(23.53%)were located on the right side,2 cases(11.76%)were located on both sides;among 40 patients with right VAH,3 cases(7.5%)had infarction lesions on the left side and 34 cases(85%)were located on the right side,there were 3 cases(7.5%)with infarct lesions located on both sides.Conclusions:1.Compared with the non-VAH group,the VAH group is easier to merge FTP.2.The probability of PCI lesions in the pons and inferior anterior cerebellar artery in the VAH group is lower than that in the non-VAH group.Compared with the non-VAH group,the PCI lesions were not significantly related to the medulla oblongata,posterior inferior cerebellar artery blood supply area,midbrain,thalamus,occipital lobe,and temporal lobe.3.Compared with the non-VAH group,the probability of VAD in the VAH group is higher than that in the non-VAH group.