非急性期颅内椎基底动脉闭塞介入再通的中长期随访研究  

Mid- and long-term follow-up of revascularization and stenting of nonacute intracranial vertebrobasilar artery occlusion

作　　者：贺迎坤[1] 李天晓[1] 王子亮[1] 常凯涛 朱良付[1] 薛绛宇[1] 白卫星[1] 冯光[1] 

机构地区：[1]郑州大学人民医院介入科脑血管病区河南省人民医院国家高级卒中中心 河南省介入治疗中心,450000

出　　处：《中华放射学杂志》2017年第2期145-148,共4页Chinese Journal of Radiology

基　　金：国家“十二五”科技支撑计划（2011BA108804）;河南省重点科技攻关项目（152102310416,162102310268）;河南省卫生科技攻关项目（201403191）

摘　　要：目的评价介入再通治疗非急性期颅内椎基底动脉闭塞的中长期临床疗效。方法回顾性分析2010年2月到2012年4月闭塞超过24h的非急性颅内椎基底动脉闭塞，并行介入再通治疗的27例患者的临床资料。分析围手术期并发症、随访期间短暂性脑缺血发作及卒中发生情况。使用非参数秩和检验比较手术前后及随访期间的改良Rankin量表（mRS）评分变化情况。结果27例患者中有26例闭塞动脉成功开通。术后13例患者病情改善，11例稳定，3例恶化；mRS评分Ⅲ（四分位数范围，IR）1由术前的4（2—5）分恢复到出院时的3（1～5）分。围手术期发生并发症5例，其中3例并发症导致神经症状加重。19例患者影像随访10（7-18）个月，再发狭窄6例，其中3例为症状性。27例患者临床随访55（50～59）个月，再发同侧卒中2例，同侧短暂性脑缺血发作2例。术后7d与术前（Z=3．116，P=0．002）、术后3个月与术后7d天（Z=2．977，P=0．003）、术后12个月与术后3个月（X=2．977，P=0．003）的mRS评分相比差异有统计学意义。结论介入再通治疗非急性期颅内椎基底动脉闭塞可在中远期预防再发缺血事件的发生，同时术后1年内患者的残疾功能改善明显。Objective To evaluate the mid- and long-term follow-up outcome of revascularization and stenting of nonaeute intracranial vertebrobasilar artery occlusion. Methods Consecutive data of 27 patients who suffered from nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours and underwent endovascular revascularization, were retrospectively collected and analyzed. Complications and recurrent ischemic events during the follow-up period were recorded. The modified Rankin scale （mRS） scores were used and compared between pre- and postoperation. Results All 27 patients except one （96.3 %） obtained successful recanalization. After the procedure, 13 patients showed improvement, 11 were stable, and 3 worse. The decline of median mRS scores, which was 4 （ interquarter range-IR, 2-5） preoperatively and 3 （IR, 1-5） on discharge. Five patients suffered from procedural complications and three of them resulted in aggravation. Nineteen patients received imaging follow-up during the median 10 months, 6 restenosis occurred and 3 of them were symptomatic. During median 55 months clinical follow-up after operation, 2 ipsilateral stroke and 2 ipsilateral transient ischemic attack occurred. The mRS scores decreased significantly in the first one year after procedure. Conclusions Revascularization and stenting of nonacute intracranial vertebrobasilar artery occlusion can prevent recurrent ipsilateral ischemic event and improve disability recovery in the first one year.

关 键 词：动脉闭塞性疾病 椎底动脉供血不足 放射学 介入性 非急性期 

分 类 号：R743.3[医药卫生—神经病学与精神病学]