Clinical Analysis Of Vertebral Artery Dominance

Objective:To investigate the relationship between vertebral artery dominance and posterior circulation infarction ?trigeminal neuralgia and other nervous system diseases by magnetic resonance angiography.And further study the pathogenesis of them..Methods:The patients were selected in department of internal medicine who took the head MRI and head MRA examination from October 2013 to July 2014 in the Liaoning Provincial People's Hospital.To collect the General information,medical history and laboratory test result of patients.Inclusion criteria: hospitalized patients;clinical data integrity.Clinical data integrity is consistent with the following requirements: a complete medical history,improve the head MRI and MRA examination,improve hemoglobin,total cholesterol(TCH),blood glucose,C-reactive protein and fibrinogen and other blood biochemical indicators.Exclusion criteria: Patients with intracranial tumor;vertebral artery stenosis or agenesis;anterior circulation infarction;patients with severe internal medicine;MRI(magnetic resonance imaging)and MRA(magnetic resonance angiography)examination revealed at least one side vertebral artery completely undeveloped or at least one side of the intracranial segment of vertebral artery stenosis.A total of 449 patients were included,according to MRA imaging,the patients were divided into the advantage group of vertebral artery(dominant group)and non vertebral artery dominance group(non dominant group).Analysis of vertebral artery dominance group and non dominant groups of patients with posterior circulation infarction,dizziness,trigeminal neuralgia of nervous system diseases incidence;vertebral artery dominance and position of posterior circulation infarction,infarct laterality;vertebral artery and basilar artery in the bending of the occurrence rate and relationship of the side of the bending.Through MRA measured bilateral vertebral artery diameter,and calculate the difference in bilateral vertebral artery diameter;vertical distance of each patient was measured from the standard line of basilar artery to the basilar artery the bend point,namely the basilar artery bending length(BL);according to the trigeminal nerve pain score table,for each of the trigeminal nerve pain with assessment score record,Pearson analysis applied among them..Results:A total of 449 patients were included in the study.Among the 449 patients,236 patients were in vertebral artery dominance and 213 patients in non-dominant vertebral artery.The incidence of vertebral artery dominance was 52.56%.The age,sex,history of previous medical history and blood tests of the two groups were compared and analyzed,and the results were not statistically significant(P>0.05).Among the included patients,compared to the non dominant group,there were 105 cases(105/449,23.39%)of posterior circulation infarction,39 cases(39/449,8.68%)of paroxysmal vertigo and balance disorders,12 cases(12/449,2.67%)of facial spasm,37 cases(37/449,8.24%)of trigeminal neuralgia,there was significant difference(P<0.05)between these 2 groups.There was no significant difference in the incidence of migraine and simple dizziness in the dominant group compared with the non dominant group(P>0.05).449 cases of patients in circulation infarction occurred in posterior cerebral of 199 cases,including 27 cases in the region PICA patients with vertebral artery advantage(27 / 199,13.57%),BA area advantage group containing 45 patients(45 / 199,22.61%),SCA zone containing advantage group of 12 patients(12 / 199,6.03%),PCA area containing advantage of 21 patients(21 /199,10.55%);Compared with the non dominant group,there were statistically significant differences between the two groups(P < 0.05)in the groups of PICA and BA.There were 105 cases of vertebral artery dominance in posterior circulation infarction,the PICA infarction occurred in vertebral artery dominance of opposite side in 20 cases(19.05%);BA infarction occurred in dominant vertebral artery of ipsilateral side 32 cases(30.48%),SCA area 12 cases(11.43%),PCA area 19(18.10%),between the two groups were compared with statistical significance(P < 0.05).Dominant group of 236 cases exist 117 patients of basilar artery curvature 49.58%(117/236),33 cases(33/213,15.49%)of patients exist basilar artery bending in non dominant group,the difference between the two groups has statistical significance(P < 0.05);There were 92 cases(92/117 and 78.63%)patients with basilar artery bent to the right,4 cases toward the left(4/117,3.4%),the difference has statistical significance(P < 0.05);73 cases of vertebral artery dominance of right side with 20 cases of patients with basilar artery to the left bend(20/117,17.09%),1 case of right lateral bending(1/117,0.85%),the difference has statistical significance(P < 0.05).The basilar artery bending direction mainly partial to vertebral artery dominance on the opposite side.Through the calculation and evaluation: the difference between the left and right sides of the vertebral artery diameter of 0.32±0.15 mm,trigeminal neuralgia score 3.98±0.71 points,the basilar artery bending length of 3.78±1.74 mm.Correlation analysis using Pearson,the difference of vertebral artery diameter and the degree of trigeminal neuralgia(score)was positively correlated(r=0.597,P=0.000);and the length of the basilar artery was positively correlated(r=0.712,P=0.000).Conclusion:(1)The vertebral artery dominance had a high rate in population,which left side was higher than the right side.(2)Among the vertebral artery dominance population,the incidence rate of sudden dizziness with balance disorders,trigeminal neuralgia,hemifacial spasm and other nervous system disease is high.(3)The patients of vertebral artery dominance maybe have a high risk to occur posterior circulation infarction in PICA and BA area.(4)The incidence of basilar artery curvature in patients with vertebral artery advantage is high,and its bending direction is opposite to that of the vertebral artery.(5)The diameter difference of bilateral vertebral artery was positively correlated with the length of basilar artery,the more obvious the advantage of vertebral artery,the longer the length of basilar artery,the more serious the trigeminal neuralgia.