A Study Of Influence Factors And Characteristics Of Collateral Circulation Formation In Patients With VBA Stenosis Or Occlusion

Objective Through a retrospective study,the factors influencing the formation of collateral circulation in patients with vertebrobasilar artery stenosis or occlusion and the characteristics of compensation pathways were analyzed,in order to provide some reference for further clinical treatment and intervention.Methods A retrospective analysis was performed on the data of patients admitted to the Department of Neurology,The Third Affiliated Hospital of Southern Medical University from September 2019 to March 2022,who met the inclusion and exclusion criteria and were diagnosed with vertebral-basilar artery stenosis or occlusion by digital subtraction angiography(DSA)in our hospital.By DSA results divided the patients into mild-to-moderate vertebral-basilar artery stenosis group and severe stenosis or occlusion,and based on ASITN/SIR score,divided the patients into collateral circulation bad and good collateral circulation group,the clinical data of patients with statistical in different vascular stenosis degree and different distribution of collateral circulation condition.The risk factors affecting the establishment of collateral circulation in patients with vertebral-basilar artery stenosis or occlusion were analyzed and ROC curves were drawn.Results A total of 52 patients were included in this study,among them,23 patients(44.2%)had vertebral-basilar artery mild to moderate stenosis.There were 29 patients(55.8%)with severe stenosis or occlusion,31 patients(59%)with good collateral circulation,and 21 patients(40.5%)with poor collateral circulation.Univariate analysis of poor collateral circulation group and good collateral circulation group showed that:Patients with poor collateral circulation had higher fasting blood glucose(p=0.007),higher hBA1c(p=0.007)and higher serum homocysteine(p=0.006)than those with good collateral circulation(p<0.05).Univariate analysis of mild to moderate stenosis group and severe stenosis or occlusion group showed that:Compared with the group with mild to moderate vertebrobasilar artery stenosis,there were more patients with previous cerebrovascular history in the group with severe vertebrobasilar artery stenosis or occlusion(p=0.043)and higher serum homocysteine level(p=0.006),the difference was statistically significant(p<0.05).The classification of collateral circulation establishment status was taken as the dependent variable,and fasting blood glucose,hba1c and homocysteine with statistical differences in univariate analysis were included in multivariate logistic regression analysis as independent variables.The results showed that serum homocysteine level(OR 1.238,95%CI 1.029-1.490,p=0.024)was an independent risk factor for collateral circulation establishment in patients with vertebrobasilar artery stenosis OR occlusion.Conclusion (1)High serum homocysteine level is an independent risk factor for collateral circulation formation after vertebrobasilar artery stenosis or occlusion.(2)The area under ROC curve for predicting poor collateral circulation formation after vertebralbasilar artery stenosis or occlusion by homocysteine value was 0.727,the maximum approximate index was 0.373,the sensitivity was 85.7%,and the specificity was 48.4%.Therefore,we found that high homocysteine value can be used as a reference index for predicting adverse collateral circulation formation and prior intervention in patients with vertebrobasilar artery stenosis or occlusion.