椎动脉发育不良与后循环易损性：流行病学、血流动力学及临床证据的系统综述。

文献信息

中文摘要

背景/目的： 椎动脉发育不良是椎动脉常见的先天性解剖变异，传统上被认为是一种良性发现。然而，越来越多的证据提示，VAH可能影响椎基底动脉血流动力学，并导致对后循环疾病的易感性。本系统综述旨在综合当前关于VAH相关流行病学、血流动力学意义、神经系统表现及脑血管结局的证据。
方法： 本系统综述按照PRISMA 2020指南进行，并在PROSPERO注册（CRD420261442242）。对PubMed/MEDLINE进行了从数据库建立至2026年6月8日的系统检索，并辅以手工参考文献筛查和针对性检索。纳入评估通过血管成像或解剖评估诊断VAH的研究，包括CTA、MRA、多普勒超声和DSA。使用Joanna Briggs Institute批判性评价工具评估方法学质量，并根据牛津循证医学中心框架对证据水平进行分类。
结果： 共纳入46项研究进行定性综合。VAH患病率因成像方式、诊断标准和研究人群不同而差异很大，范围约为3%至近50%。在临床队列中，VAH常与后循环缺血性卒中、短暂性脑缺血发作和椎基底动脉供血不足相关。血流动力学研究显示椎动脉血流减少、血管阻力增加、脑血管反应性受损以及侧支血流重分布改变。VAH还与前庭疾病、非卒中神经系统综合征、椎动脉夹层及其他脑血管解剖变异相关。与既往主要关注患病率或卒中关联的综述不同，本综述在统一的临床导向框架内整合了流行病学、解剖学、血流动力学、计算和神经学证据，并提出一个循证概念模型，将VAH视为一种情境依赖性的低血流血管易感性表型。
结论： 当前证据表明，VAH是一种具有临床相关性的血管易感性表型，而不仅仅是偶然的解剖变异。其临床意义似乎取决于椎动脉血流减少、侧支能力、血管重塑和获得性脑血管危险因素之间的相互作用。需要标准化诊断标准和前瞻性多模式研究来确定其在未来脑血管风险评估中的作用。

英文摘要

BACKGROUND/OBJECTIVES: Vertebral artery hypoplasia is a common congenital anatomical variant of the vertebral arteries, traditionally considered a benign finding. However, accumulating evidence suggests that VAH may influence vertebrobasilar hemodynamics and contribute to susceptibility to posterior circulation disorders. This systematic review aimed to synthesize current evidence regarding the epidemiology, hemodynamic significance, neurological manifestations, and cerebrovascular outcomes associated with VAH.
METHODS: This systematic review was conducted according to the PRISMA 2020 guidelines and registered in PROSPERO (CRD420261442242). A systematic search of PubMed/MEDLINE was performed from database inception to 8 June 2026, supplemented by manual reference screening and targeted searches. Studies evaluating VAH diagnosed using vascular imaging or anatomical assessment, including CTA, MRA, Doppler ultrasonography, and DSA, were eligible. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools, and the level of evidence was classified according to the Oxford Centre for Evidence-Based Medicine framework.
RESULTS: Forty-six studies were included in the qualitative synthesis. VAH prevalence varied substantially according to imaging modality, diagnostic criteria, and study population, ranging from approximately 3% to nearly 50%. Across clinical cohorts, VAH was frequently associated with posterior circulation ischemic stroke, transient ischemic attack, and vertebrobasilar insufficiency. Hemodynamic studies demonstrated reduced vertebral artery flow, increased vascular resistance, impaired cerebrovascular reactivity, and altered collateral flow redistribution. VAH was also associated with vestibular disorders, non-stroke neurological syndromes, vertebral artery dissection, and other cerebrovascular anatomical variations. Unlike previous reviews focusing primarily on prevalence or stroke associations, this review integrates epidemiological, anatomical, hemodynamic, computational, and neurological evidence within a unified clinically oriented framework and proposes an evidence-informed conceptual model of VAH as a context-dependent low-flow vascular susceptibility phenotype.
CONCLUSIONS: Current evidence indicates that VAH represents a clinically relevant vascular susceptibility phenotype rather than merely an incidental anatomical variant. Its clinical significance appears to depend on the interaction between reduced vertebral artery flows, collateral capacity, vascular remodeling, and acquired cerebrovascular risk factors. Standardized diagnostic criteria and prospective multimodal studies are required to define its role in future cerebrovascular risk assessment.