椎动脉狭窄颈部CTA与DSA诊断差异及支架治疗疗效观察  

Difference of diagnosis by CT angiography and DSA for patients with vertebral artery stenosis and efficacy observation of stenting

作　　者：周进[1] 杨勇[1] 邓伟华[1] 黄翚[1] 潘小平[1] 

机构地区：[1]广州市第一人民医院神经内科,广州510180

出　　处：《中华神经医学杂志》2012年第12期1247-1250,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨颈部CTA检查在椎动脉狭窄诊断中的重要作用以及应用血管内支架成形术治疗症状性椎动脉狭窄的可行性及安全性。方法回顾性分析自2007年5月至2011年4月在广州市第一人民医院神经内科住院的椎动脉系统脑梗死患者，所有患者均完善颈部CTA及颅脑MRA检查．若筛选发现可能存在椎动脉狭窄，则行DSA检查。经DSA确诊为椎动脉狭窄的患者在个体评估并知情同意后行椎动脉支架成形术。结果颈部CTA检查发现38例椎动脉狭窄后循环脑梗死患者，均经DSA证实并予椎动脉支架成形术治疗。29例患者颈部CTA发现有〉50％椎动脉狭窄共38处，其中V4段狭窄8处，V1段狭窄30处；DSA证实仅4处V4段狭窄和28处V1段狭窄超过50％。另有9例颈部CTA示椎动脉Vl段显示不清，而DSA明确其狭窄〉50％。38例患者共置入椎动脉支架41枚，支架成形术成功率100％，术后平均狭窄率（11．6％±8．9％）较术前（65．0％±11．2％1明显降低。术后随访6-25个月，1例发生脑干腔隙性梗死，1例脑干梗死呈闭锁状态．1例椎动脉V4段狭窄患者发生蛛网膜下腔出血。结论颈部CTA检查对椎动脉狭窄的诊断能提供较大帮助。血管内支架成形术是治疗症状性椎动脉狭窄安全、有效的方法。Objective To observe the significance of neck CT angiography （CTA） in detectingthe vertebral artery stenosis, and to study the feasibility and safety of stenting and angioplasty in patients with symptomatic vertebral artery stenosis. Methods Patients with ischemic stroke in the posterior circulation, admitted to our hospital from May 2007 to April 2011, were chosen in our study; all the patients were performed neck CTA and brain MRA; If there might be vertebral artery stenosis in the CTA, DSA was chosen. Patients diagnosed as having vertebral artery stenosis by DSA were performed stenting and angioplasty after being individual assessment and informed consent. Results Thirty-eight patients diagnosed as having ischemia in the posterior circulation and vertebral artery stenosis were received stenting and angioplasty. There were 38 vertebral artery stenoses （above 50%） detected by neck CTA in 29 patients, among which, 30 stenoses were in the V1 part of vertebral artery and 8 in the V4 part; while these 29 patients detected by DSA only showed 4 stenoses in the V4 part and 28 in the V1 part （above 50%）. And 9 patients with V1 part of vertebral artery stenosis （above 50%） couldn＇t be found by neck CTA but diagnosed by DSA finally. These 38 patients treated with 41 stents, which were all successful （achievement ratio 100%）. The mean ratio of stenosis before stenting was （65.0±11.2）% and the mean ratio after stenting was （11.6±8.9）%, with significant difference. One patient experienced lacunar infarction and 1 severe stroke with lock in syndrome during the 6-25 months of follow-up; and 1 patient experienced subarachnoid hemorrhage after the procedure. Conclusion The neck CTA is useful in the screening of vertebral artery stenosis. Stenting and angioplasty are the safe and effective treatments for patients with symptomatic vertebral artery stenosis.

关 键 词：椎动脉狭窄 脑梗死 CT血管造影术 数字减影血管造影技术 血管内支 架成形术 

分 类 号：R743.31[医药卫生—神经病学与精神病学]