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目的 探讨椎动脉优势(vertebral artery dominance)与后循环梗死发生率及梗死侧的关系.同时了解椎动脉优势与基底动脉弯曲的相关性.方法 134例缺血性脑血管疾病、脑出血及突发性耳聋患者根据其是否存在椎动脉优势分为有椎动脉优势68例(优势组)和无椎动脉优势66例(对照组).比较两组间后循环梗死总发生率,后循环各部位的梗死发生率以及基底动脉弯曲的发生率.统计优势组各梗死部位后循环梗死侧与椎动脉优势侧的相关性,基底动脉弯曲方向与椎动脉优势侧的相关性,基底动脉弯曲与否与后循环梗死的相关性.结果 优势组后循环梗死发生率高于对照组[45.6％ (31/68)与21.2％(14/66),x2=8.922,P=0.003].优势组小脑后下动脉(PICA)供血区梗死及基底动脉供血区梗死发生率显著高于对照组[11.8％ (8/68)与0,x2=8.250,P=0.004;20.6％(14/68)与7.6％ (5/66),x2=4.660,P =0.031]；两组的小脑上动脉供血区梗死率及大脑后动脉供血区梗死率差异无统计学意义.7例(7/8) PICA梗死患者梗死侧在椎动脉优势对侧.6例(6/14)基底动脉区梗死患者梗死侧与优势侧同侧.优势组基底动脉弯曲发生率显著高于对照组[50.0％(34/68)与9.1％ (6/66),x2=26.768,P=0.000].优势组基底动脉弯曲患者后循环梗死发生率与基底动脉呈直线的患者相仿,差异无统计学意义[ 52.9％ (18/34)与38.2％ (13/34),x2=1.482,P=0.223].优势组34例基底动脉弯曲的患者中,97.1％ (33/34)弯曲向椎动脉优势对侧.结论 椎动脉优势的患者较易发生后循环梗死,尤其是PICA和基底动脉供血区梗死,PICA供血区梗死部位一般在椎动脉优势对侧.椎动脉优势患者易致基底动脉弯曲,基底动脉一般弯向椎动脉优势对侧.

Objective To investigate the correlation of vertebral artery dominance (VAD) with incidence and laterality of posterior circulation infarct,and observe the correlation of VAD and basal artery (BA) curvature.Methods Total incidence of posterior circulation infarcts,incidence of separate territory infarcts in posterior circulation and incidence of BA curvature were compared between 68 VAD patients and 66 controls.VA dominance,laterality of BA curvature and separate territory infarcts,and their directional relationships were observed in VAD group.Results The total incidence of posterior circulation infarcts in VAD group was significantly higher than that in controls(45.6％ (31/68) vs 21.2％ (14/66),x2 =8.922,P =0.003 ).The incidences of posterior inferior cerebellar artery (PICA) territory infarct and BA territory infarct were both significantly higher than that in controls ( 11.8％ ( 8/68 ) vs 0,x2 =8.250,P =0.004 ;20.6％ (14/68) vs 7.6％ (5/66),x2 =4.660,P =0.031 ).No differences were found in superior cerebellar artery (SCA) and posterior cerebral artery ( PCA ) territory infarcts between two groups.87.5 ％ (7/8) PICA infarcts were on the opposite side of dominant VA.42.9％ (6/14) BA infarcts were on the side of dominant VA.The incidence of BA curvature was significantly higher than that in controls(50.0％ (34/68) vs 9.1％ (6/66),x2 =26.768,P =0.000 ).No differences were found in the incidences of posterior circulation infarcts between BA curvature patients and BA straight patients(52.9％ (18/34) vs 38.2％ ( 13/34),x2 =1.482,P =0.223 ).97.1％ (33/34)patients had an opposite directional relationship between dominant VA and BA curvature in 37 BA curvature patients in VAD group.Conclusions The incidence of posterior circulation infarcts is higher in VAD patients,especially in PICA infarct and BA infarct patients.Most PICA infarcts occurred on the opposite side of dominant VA.The incidence of BA curvature is higher in VAD patients,and BA usually bends to the opposite side of dominant VA.