Objective To analyze the correlation between vertebral artery asymmetry and vertebral artery origin stenosis(VAOS)lesions in population without risk factors for cardiovascular and cerebrovascular diseases.Methods A total of 6 423 participants without cardiovascular and cerebrovascular high-risk factors who underwent cervical atherosclerosis ultrasound screening in the"standardized evaluation database for cerebral vascular ultrasound screening in the high-risk population of stroke"from December 2019 to December 2021 were consecutively enrolled.The general information of the participants was collected before the examination,including gender,age,body mass index(BMI),and bilateral vertebral artery ultrasound parameters,i.e.,the internal diameter of the intervertebral segment(V2 segment)and the degree of VAOS(mild,moderate,severe,and occlusion)assessed by hemodynamic parameters(peak systolic flow velocity[PSV],end-diastolic flow velocity[EDV],and PSVinitiation/PSVintervertebral segment).According to the ultrasound results,the participants were divided into VAOS group and no stenosis group(non-VAOS group).Vertebral artery diameter ≤ 2.0 mm was defined as vertebral artery hypoplasia(VAH).According to the difference in the inner diameter of the V2 segment of the bilateral vertebral arteries,the participants were classified as vertebral artery dominance(VAD)group(inner diameter difference ≥1.2 mm)and non-VAD group(inner diameter difference＜1.2 mm).In the final statistical analysis,if there is a side involved,each group will be counted by the number of cases,and if no side differentiation is involved,each group will be counted by the number of cases.Taking the occurrence of VAOS as the dependent variable,the general information and anatomical factors(VAH,VAD)were analyzed by univariate Logistic regression.The item of P＜0.05 was used as the independent variable,and the independent influencing factors of VAOS were further analyzed by multivariate Logistic regression.Results A total of 6 423 participants were included,including 1 985 males and 4 438 females,with an average age of(43±13)years from 19 to 80 years.There were 628 cases in the VAD group and 5 795 cases in the non-VAD group.(1)Compared with the VAD group,the proportion of females in the non-VAD group was higher(69.9％vs.61.3％,P＜0.01),and the age was younger([43±13]vs.[45±14]years,P＜0.01),and the proportion of those aged＜40 years was higher than that in the VAD group(46.3％vs.38.4％,P＜0.01).The proportion of VAH patients and the incidence of VAOS were lower than those in the VAD group(0.6％vs.17.2％and 1.5％vs.4.0％,respectively,both P＜0.01).(2)Univariate Logistic regression analysis of the incidence of VAOS among participants without cardiovascular and cerebrovascular risk factors showed that the proportion of male,age,BMI,VAH and VAD ratios in the VAOS group were higher than those in the non-VAOS group,with statistical significance(all P＜0.05).Multivariate Logistic regression analysis showed that male(OR,1.92,95％CI 1.30-2.85,P=0.001),age(OR,1.12,95％CI1.10-1.14,P＜0.01)and VAD(OR,2.14,95％CI 1.30-3.40,P=0.002)were independent risk factors for VAOS in participants without cardiovascular and cerebrovascular risk factors.Conclusions The occurrence of VAD is affected by gender and age.VAD is an independent risk factor for VAOS in population without cardiovascular and cerebrovascular risk factors.

Objective To investigate the association between vertebral artery origin stenosis(VAOS)and the degree of bilateral vertebral artery diameter asymmetry caused by vertebral artery dominance(VAD)in patients cardiovascular and cerebrovascular disease risk factors and the optimal diameter difference(△D)cutoff value for diagnosing VAD.Methods A total of 6 404 subjects without vertebral artery occlusion and risks factors of cerebrovascular disease including hyperlipidemia,hypertension,diabetes,obesity(body mass index[BMI]≥ 28 kg/m2),smoking history,and drinking history were retrospectively enrolled from the Standardized Evaluation Database for Screening of High-risk Groups for Stroke from December 2019 to December 2021.The age,sex,BMI,bilateral vertebral artery△D,and VAOS evaluated by the systolic peak velocity and end-diastolic velocity of the vertebral artery origin and intervertebral segment were collected.Subjects with stenosis rate≥50％were divided into VAOS group,and the rest were divided into control group.The general data and △D of the two groups were compared.The items with statistically significant differences were enrolled into multivariable Logistic regression analysis in which ≥50％VAOS was used as the dependent variable.The VAOS group and the control group were matched at a ratio of 1∶5 using propensity score matching.The receiver operating characteristic(ROC)curve was drawn based on ≥50％VAOS as the outcome indicator and △D as the independent variable after matching.The area under the curve(AUC)was calculated.The Youden index was used to calculate the optimal cutoff value of △D.Results Among the 6 404 patients included,there were 1 975 males and 4 429 females.Among them,46 patients were in the VAOS group,and the incidence of VAOS was 0.72％.(1)The results of univariate Logistic regression analysis showed that the male proportion,age,BMI and △D in the VAOS group were higher than those in the control group(P＜0.05).The above variables were further included in the multivariate Logistic regression analysis and the results showed that male(OR,2.49,95％CI 1.36-4.67,P=0.003),age(OR,1.14,95％CI 1.11-1.17,P＜0.01)and △ D(OR,1.81,95％CI 1.06-2.97,P=0.024)were risk factors for VAOS.(2)After propensity score matching,46 cases were included in the VAOS group and 230 cases were included in the control group,for a total of 276 cases.The inter-group comparison showed that the △D in the VAOS group was higher than that in the control group(0.65[0.30,1.20]mm vs.0.40[0.20,0.80]mm,P=0.009).There were no significant differences in the other baseline data between the groups(P＞0.05).(3)Based on 276 subjects matched by propensity score,the ROC curve analysis with the occurrence of VAOS as the outcome indicator and △D as the independent variable showed that the AUC of △D for predicting ≥50％VAOS was 0.622,the optimal cutoff value was 0.800 mm,the specificity was 78.3％,and the sensitivity was 41.3％.Conclusions The difference in the diameter of the bilateral vertebral arteries in patients without cardiovascular and cerebrovascular disease risk factors is associated with the occurrence of ≥50％VAOS.The optimal cutoff value of the diameter difference is 0.800 mm,which can be used as a reference standard for defining VAD.The diameter difference 0.800mm indicates a higher risk of VAOS with stenosis rate ≥50％(specificity 78.3％,sensitivity 41.3％).The results of this study need to be further verified.