老年颅内椎基底动脉粥样硬化性狭窄患者支架成形术后新发无症状性脑梗死特征分析  

Characteristics of new asymptomatic ischemic stroke in elderly patients with intracranial vertebrobasilar artery stenosis after stenting

作　　者：赵宇 金旻 刘奇 谢育英 杜彬 ZHAO Yu JIN Min LIU Qi et al(Department of Neurointerventional Medicine ,General Hospital of Chinese PLA Rocket Force,Beijing 100088, China)

机构地区：[1]火箭军总医院神经介入医学科,北京100088 [2]火箭军总医院超声科,北京100088

出　　处：《中华老年心脑血管病杂志》2017年第2期117-120,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：北京市科技计划项目(Z151100004015207)

摘　　要：目的分析颅内椎基底动脉粥样硬化性狭窄患者支架成形术前及术后MRI弥散加权成像(DWI),研究其新发脑梗死,尤其是无症状性脑梗死。方法选择支架成形术治疗症状性颅内椎基底动脉粥样硬化性重度狭窄患者54例。术后24h内复查MRI DWI,并与术前对比。术后随访主要观察指标包括30d内任何脑卒中或死亡及头颅DWI结果。结果 54例患者中,手术成功率100.0%。2例(3.7%)术后DWI证实症状性穿支脑梗死,其中1例合并颅内出血。24例术后无症状患者行头颅DWI复查,发生无症状性脑梗死7例(29.2%),其中脑梗死类型为穿支脑梗死1例(14.3%),栓塞性脑梗死5例(71.4%),混合性脑梗死1例(14.3%);发生栓塞性脑梗死的6例患者中,栓塞性脑梗死累及小脑后下动脉4例(66.7%),小脑上动脉3例(50.0%),大脑后动脉2例(33.3%)。结论 MRI可分析颅内椎基底动脉支架成形术后新发脑梗死特征,新发无症状性脑梗死主要类型为栓塞性脑梗死。Objective To study the characteristics of new ischemic stroke,especially asymptomatic ischemic stroke,in elderly patients with intracranial vertebrobasilar artery stenosis after stenting by analyzing their DWI before and after stenting.Methods Fifty-four patients with symptomatic intracranial vertebrobasilar atherosclerotic artery stenosis who underwent multimodal imagingguided stenting in our hospital were included in this study.The patients undertwent head MRI scanning within 24 hafter stenting and were followed up for 30 days during which the incidence of ischemic stroke and death,and findings on head MRI were recorded.Results The success rate of stenting was 100.0%.Of the 54 patients,2（3.7%）were diagnosed with symptomatic perforating infarction and 1with intracranial hemorrhage after stenting.Out of the 24 asymptomatic patients who underwent head DWI,asymptomatic ischemic stroke,perforating ischemic stroke,embolic ischemic stroke and mixed ischemic stroke occurred in 7（29.2%）,1（14.3%）,5（71.4%）and 1（14.3%）respectively.Out of the 6patients with embolic ischemic stroke,embolic ischemic stroke involving osterior inferior cerebellar artery,inferior cerebellar artery and superior cerebellar artery occurred in 4（66.7%）,3（50.0%）and 2（33.3%）respectively.Conclusion MRI can show the characteristics of new ischemic stroke in elderly patients with intracranial vertebrobasilar artery stenosis after stenting.The incidence of asymptomatic ischemic stroke is 29.2%.Embolic ischemic stroke is the main type of new asymptomatic ischemic stroke.

关 键 词：颅内动脉硬化 椎底动脉供血不足 支架 磁共振成像 弥散 脑梗死 

分 类 号：R743.33[医药卫生—神经病学与精神病学]