Clinical And Imaging Features Of Posterior Circulation Cerebral Infarction In The Prediction Of Vascular Lesions

[Aim]1. To investigate the correlation between vascular lesion and posterior circulationinfarction and its influence;2. To investigate the relative risk factors of vascular lesion in posterior circulation;3. To investigate the role of posterior circulation infarction site in the prognosis of vascularlesion;4. To investigate the role of clinical features in the prognosis of vascular lesion;[Methods]Data for this retrospective study was collected from the hospitalization patients ofdepartment of neurology or neurosurgery in Affiliated Drum Tower Hospital of NanjingUniversity Medical School and Jingjiang City People’s Hospital from March2010toDecember2013, which include172patients with posterior circulation ischemia. BrainMRI was done to identify the new infarction, digital subtraction angiography wasperformed to detect the vascular lesion. Also, the sex, age, biochemical marker, relativemedical history and clinical features were recorded. Posterior circulation infarction wasdivided into proximal segment, middle segnent and distal segment according to brain MRIimaging, National Institute of Health stroke scale (NIHSS) was used to assess the severityof stroke.(1) The distribution difference of different cerebrovascular stenosis wascompared between with and without infarction, then the role of severe vascular stenosis orocclusion in the pathogenesy of cerebral infarction and its relative risk factors wasanalyzed.(2)Imaging distribution pattern of posterior circulation infarction and its relativity with severevascular stenosis or occlusion was analyzed.(3) Correlation between clinical features ofposterior circulation infarction and severe vascular stenosis or occlusion was analyzed.[Results]1. Significant difference of different cerebrovascular stenosis was existed between withand without infarction (Χ2=7.881, P=0.019), the percent of severe stenosis or occlusionwas higher in the group of infarction (63%vs41%, P<0.05); Logistic regression demonstrated that severe vascular stenosis or occlusion was the important risk factor ofposterior circulation infarction (OR=2.293,95%CI=1.180-4.455, P=0.014), it was still theindepent risk factor despite after adjusting by triglyceride, high density lipoproteincholesterol and fibrinogen (OR=2.947,95%CI=1.407-6.174, P=0.004); Hypertension anduric acid was the important risk factor of severe vascular stenosis or occlusion, and the OR(95%CI, P value) was3.574(1.774-7.204,0.000) and1.004(1.001-1.007,0.010)respectively;2. Percent of severe vascular stenosis or occlusion was different in the different infarctionsite of posterior circulation, it was higher in the proximal segment than that in the middlesegnent and distal segment (82%vs51%or59%, P=0.006or0.039); If middle segmentwas set as the reference, the OR (95%CI, P value) of proximal segment and distal segmentwere1.357(0.592-3.110,0.470) and4.423(1.455-13.448,0.009）respectively throughlogistic regression; Due to severe vascular stenosis or occlusion was more prone to exist inthe vertebral artery, the correlation between severe vascular stenosis or occlusion ofvertebral artery and infarction of proximal segment was analyzed, which demonstrated thatthere had the significant correlation, the R and P were0.343and0.000respectively;Logistic regression of infarction in the proximal segment revealed, if non-severe vascularstenosis or occlusion of vertebral artery was set as the reference, the OR (95%CI, P value)of severe stenosis and occlusion were3.167(1.023-9.802,0.046) and15.437(4.567-52.180,0.000）respectively through logistic regression;3. Percent of severe vascular stenosis or occlusion was different in the different farction ofposterior circulation. The more severe of stroke, the higher percent of severe vascularstenosis or occlusion. Compared to the group of NIHSS<4, the percent increasedsignificantly in the group of NIHSS>8(73%vs47%, P=0.023); If the group of NIHSS<4was set as the reference, the OR (95%CI, P value) of NIHSS between4and7andNIHSS>8were2.228(0.952-5.215,0.065) and3.162(1.155-8.656,0.025) respectivelythrough logistic regression.There had no correlation between severe vascular stenosis orocclusion and exact clinical symptom.[Conclusions]1. Posterior circulation infarction is significantly correlated to the severe vascular stenosisor occlusion in the posterior circulation;2. Infarction in proximal segment is more prone to have the severe vascular stenosis or occlusion in the posterior circulation, especially in vertebral artery;3. Serious infarction is more prone to have the severe vascular stenosis or occlusion in theposterior circulation.