Vertebral artery hypoplasia and vertebral artery dissection A hospital-based cohort study
Vertebral artery hypoplasia and vertebral artery dissection A hospital-based cohort study
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DOI：
10.1212/wnl.0000000000001284
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发表时间：
2015-02-24
期刊：
影响因子：
9.9
通讯作者：
He, Li
中科院分区：
文献类型：
--
作者：
Zhou, Muke;Zheng, Hongbo;He, Li
目的：验证椎动脉发育不全（VAH）与同侧自发性椎动脉夹层（sVAD）风险增加相关的假设，以及发育不全的椎动脉（VAs）比显性VAs更容易发生夹层的假设。方法：在本病例对照研究中，人群包括2005年至2013年间在一个大容量中心接受治疗的112例sVAD患者和224例年龄和性别匹配的对照组。通过数字减影血管造影结合无创影像诊断VAH和sVAD。采用条件logistic回归确定sVAD的独立危险因素。还评估了sVAD和VAH之间的关系以及同侧（相对于对侧）表现的可能性。结果：在单因素分析中，sVAD患者的VAH发生率高于对照组（30.4% vs 17.4%；比值比[OR] 2.1； 95%可信区间[CI] 1.2-3.6; p = 0.008），在偏头痛、高同型半胱氨酸血症、吸烟、轻微创伤、既往感染和相关结缔组织/血管疾病校正的多因素回归分析中（OR 2.0; 95% CI 1.1-3.5; p = 0.017）。在多变量模型中，偏头痛、当前吸烟和轻微创伤与sVAD相关。发育不良的sVAD比优势VAs更常被检测到（68.0% vs 32.0%; OR 4.1; 95% CI 1.7-9.7; p = 0.002）。结论：sVAD与同侧VAH相关，并且在发育不全的VAs中比在正常的VAs中更常见。
Objective:To test the hypotheses that vertebral artery hypoplasia (VAH) is associated with an increased risk of ipsilateral spontaneous vertebral artery dissection (sVAD) and that hypoplastic vertebral arteries (VAs) are more prone than dominant VAs to dissection.Methods:In this case-control study, the population comprised 112 patients with sVAD and 224 age- and sex-matched controls treated at a high-volume center between 2005 and 2013. VAH and sVAD were diagnosed by digital subtraction angiography combined with noninvasive imaging findings. Conditional logistic regression was performed to identify independent risk factors for sVAD. Relationships between sVAD and VAH and the likelihood of ipsilateral (vs contralateral) presentation were also assessed.Results:VAH was more frequent in patients with sVAD than in controls in univariate analysis (30.4% vs 17.4%; odds ratio [OR] 2.1; 95% confidence interval [CI] 1.2-3.6; p = 0.008) and in multivariate regression analysis adjusted for migraine, hyperhomocysteinemia, smoking, trivial trauma, prior infection, and associated connective tissue/vascular disorders (OR 2.0; 95% CI 1.1-3.5; p = 0.017). Migraine, current smoking, and trivial trauma were associated with sVAD in multivariate models. sVAD was more frequently detected in hypoplastic than dominant VAs (68.0% vs 32.0%; OR 4.1; 95% CI 1.7-9.7; p = 0.002).Conclusions:sVAD is associated with ipsilateral VAH and occurs more frequently in hypoplastic VAs than in their normal counterparts.