颈动脉比值与烟雾病患者大脑后动脉病变累及的相关性研究OACSTPCD

Objective To investigate the correlation between the diameter ratio of the internal carotid artery to the common carotid artery(DRICA/CCA)and posterior cerebral artery(PCA)involvement in patients with Moyamoya disease.Methods This study retrospectively included 85 consecutive inpatient patients with Moyamoya disease diagnosed by whole brain DSA in the the Department of Neurology of Jilin People's Hospital and Department of Neurosurgery of Changzhou Second People's Hospital affiliated to Nanjing Medical University from December 2017 to December 2021.Based on DSA,the included patients were divided into a PCA involvement group(41 cases)and a non-PCA involvement group(44 cases).Clinical data,including gender,age,hypertension,diabetes mellitus,hyperlipemia,smoking,history of cerebral infarction,history of cerebral hemorrhage,use of platelet aggregation inhibitor,clinical manifestation(hemorrhagic,ischemic,asymptomatic,or mixed type),and imaging characteristics,including the presence of posterior communicating artery,Suzuki staging and DRICA/CCA,were obtained and compared between the two groups.The disease severity was dichotomized according to whether the Suzuki stage is>Ⅲ.For the patients with a bilateral PCA involvement,the side with a more severe PCA involvement was included for further analyses.For the patients with unilateral PCA involvement,the involved side was included,and for the patients without PCA involvement,the side with a higher Suzuki stage was included.The factors with a P<0.10 in the univariable analysis were included in the multivariable Logistic regression analysis for determining the independent indicator of PCA involvement.The received operating characteristic(ROC)curves were obtained and then the area under the curve(AUC),the optimal cutoff,sensitivity,and specificity were calculated.Results(1)Among the 85patients,44(51.8％)had no PCA involvement.Compared to the non-PCA involvement group,the PCA involvement group had a larger proportion of males(51.2％vs.29.6％,P<0.05),while other clinical data were not significantly different between the two groups(all P>0.05).(2)The distribution of the Suzuki stage was significantly different between the two groups(P =0.030).Compared to the non-PCA involvement group,the PCA involvement group had a smaller average DRICA/CCA ratio(0.46±0.10 vs.0.58±0.11)and a higher proportion of cases with a Suzuki stage>Ⅲ(82.9％vs.52.3％;both P<0.01).The presence of posterior communicating artery was not statistically different between the two groups(P>0.05).(3)Multivariate Logistic regression analysis revealed that DRICA/CCA was an independent risk factor of PCA involvement(OR,0.401,95％CI 0.233-0.693,P = 0.001).The optimal cutoff for DRICA/CCA predicting PCA involvement in ROC curve analysis was 0.523,with an AUC of 0.785(95％CI 0.689-0.880),sensitivity of 82.9％,and specificity of 65.9％.Conclusion Patients with Moyamoya disease accompanied by PCA involvement have lower DRICA/CCA on the ipsilateral side,which is independently correlated with PCA involvement.