| Objective:This study was undertaken to investigate the imaging characteristics of vertebrobasilar artery wall in ischemic stroke patients with Vertebrobasilar Dolichoectasia(VBD)through 3.0T HR-MRI vessel wall imaging technique,and the relationship between VBD and vertebrobasilar artery plaque was further analyzed.Methods:Between February 2014 to September 2015,we collected acute cerebral infarction/TIA patients with neurological deficits signs who admitted in our hospital and excluded individuals with cerebral hemorrhage,underlying cardiogenic embolism,obvious stenosis of the extracranial segment of vertebral artery and connective tissue disease.All patients completed the 3.0T HR-MRI examination within 7 days.Finally,189 patients were enrolled in this study.The diameter and length of the vertebrobasilar artery were measured on a 3.0T HR-MRI.Patients with basilar artery diameter≥4.5 mm and length≥29.5 mm were included in the VBD group(38 patients),the remaining patients were divided into non-VBD group(151 patients).We compared the general clinical data,laboratory parameters and HR-MRI findings between the two groups.Moreover,the relationship between VBD and vertebrobasilar vascular plaques were further analyzed.Results:A male predominance was found in VBD subjects(92.1%vs 66.9%,P=0.002).Patients with VBD were older than those without(62.7± 12.5 vs 58.2± 12.5,P=0.046).VBD(+)patients had a higher frequency of posterior acute infarction(42.1%vs 18.5%,P=0.002),old infarction(23.7%vs 11.3%,P=0.047)and lacunar infarction(21.1%vs 7.9%,P=0.04)than those without VBD,and the patients in VBD group were more susceptible to the atherosclerotic plaque(39.5%vs 21.2%,P=0.02),aneurysm(7.9%vs 0.7%,P=0.017),dissection(10.5%vs 1.3%,P=0.012)and endovascular thrombosis(13.2%vs 1.3%,P=0.003)of the vertebrobasilar artery.Comparison of plaque characteristics in the two groups showed that the proportion of unstable plaque in vertebrobasilar artery in VBD group was also higher than that of non-VBD group(BA:13.2%vs 2.6%,P=0.01;VA:18.4%vs 3.3%,P=0.005).The correlation analysis between VBD and vertebrobasilar plaque showed a positive correlation(BA:rs=0.170,P=0.02;VA:rs=0.177,P=0.015).Treating plaque as a dependent variable,the binary logistic regression analysis showed that VBD was independently associated with VA plaques(OR=2.27,95%CI 1.002-5.155,P=0.049),but the statistical difference was close to the significant level(P=0.087)in terms of VBD and BA plaque after adjusting for age,hypertension and smoking.Next,the patients were divided into non plaque group,stable plaque group and unstable plaque group according to the character of plaque.The correlation analysis showed that there was a positive correlation between VBD and plaque properties(BA:rs=0.185,P=0.01;VA:rs=0.195,P=0.007).Multiple logistic regression analysis showed that VBD had independent correlation with unstable plaque after adjusting for age,hypertension.The risk of unstable plaques in the basilar and vertebral arteries in VBD patients was 6.17 times(1/0.162,95%CI 0.039-0.680,P=0.013)and 6.13 times(1/0.163,95%CI 0.047-0.567,P=0.004)compared with those without VBD.Conclusion:Ischemic stroke Patients with VBD are older and have male predominance.VBD patients are more prone to posterior vascular events and often with other vertebrobasilar artery wall lesions such as dissection,aneurysm,and atherosclerotic plaque.VBD is independently associated with the occurrence of vertebrobasilar instability plaques,which may be one of the reasons for the higher incidence of ischemic stroke in VBD patients. |
