椎-基底动脉夹层的诊断和治疗策略选择  

The diagnosis and therapeutic strategy of vertebobasilar artery dissection

作　　者：张冰[1] 王亚仙[1] 茹立新[1] 郑少俊[1] 诸金水[1] 

机构地区：[1]浙江省湖州市中心医院神经内科,313000

出　　处：《介入放射学杂志》2013年第5期358-360,共3页Journal of Interventional Radiology

摘　　要：目的探讨椎-基底动脉夹层的临床特点、诊断和治疗策略选择。方法 2007年7月至2012年6月收治椎-基底动脉夹层(VAD)患者15例,均经DSA或CTA检查确诊。单纯颈枕部头痛4例,后循环缺血(PCI)6例,蛛网膜下腔出血(SAH)5例。对4例头痛及5例SAH患者行血管内治疗;6例PCI患者予氯吡格雷(75 mg/d)或阿司匹林(100 mg/d)治疗。结果经DSA或CTA检查共发现17支椎动脉和1支基底动脉存在VAD。影像学表现为"梭形动脉瘤"7支、"珠线征"8支、"线样征"3支。6例PCI患者中,经药物治疗后临床预后均良好,经DSA复查,4例血管狭窄程度明显减轻,2例无变化。9例经血管内治疗,1例复发,再次栓塞,过程顺利,无死亡及严重并发症。结论根据VAD的临床特点选择合理的检查方式和治疗手段,大部分患者预后良好。Objective To discuss the clinical characteristics, diagnosis and therapeutic strategy of vertebobasilar artery dissection （VAD）. Methods During the period from July 2007 to June 2012, a total of 15 patients with VAD were admitted to the hospital. The diagnosis was proved by digital subtraction angiography （DSA） or CT angiography （CTA） in all patients. The clinical symptoms included cervico- occipital pain and/or headache （n = 4）, posterior circulation ischemia （PCI, n = 6） and subarachnoid hemorrhage （SAH, n = 5）. Endovascular treatment was carried out in the four patients with cervico-occipital pain and/or headache as well as in the five patients with SAH. Treatment with clopidogreal （75 mg/d） or aspirin （100 mg/d） was employed in the six patients with PCI. Results DSA and CTA revealed that 17 vertebral arteries and one basilar artery had VAD. The lesions manifested as ＂fusiform aneurysm＂ （n = 7）, ＂pearl and string sign＂ （n = 8） or ＂linear sign＂ （n = 3） on angiograph. The six patients with PCI were treated with medication, and excellent clinical results were obtained in all of them. Follow-up examination with DSA showed that obvious improvement of artery stenosis was obtained in 4 cases and no change in 2 cases. Of the nine patients who received endovascular management, recurrence was seen in one, and embolization treatment had to be carried out once more. No death or severe complications occurred in all patients. Conclusion Based on the clinical features of VAD, reasonable examination method and therapeutic means should be individually selected. With the suitable therapeutic strategy satisfactory prognosis can be obtained in most patients. （J Intervent Radiol, 2013, 22： 358-360）

关 键 词：脑卒中 椎动脉 基底动脉 夹层 后循环缺血 

分 类 号：R743.3[医药卫生—神经病学与精神病学]