症状性颅内椎-基底动脉闭塞的侧支代偿及介入开通治疗  被引量:19

The treatment of collateral compensation and endovascular revascularization for symptomatic intracranial vertebrobasilar artery occlusion

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作  者:刘恋[1] 徐晓彤[1] 马宁[1] 高峰[1] 莫大鹏[1] 孙瑄[1] 宋立刚[1] 缪中荣[1] Liu Lian Xu Xiaotong Ma Ning C.ao Feng Mo Dapeng Sun Xuan Song Ligang Miao Zhongrong.(Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China)

机构地区:[1]首都医科大学附属北京天坛医院介入神经病学科,100050

出  处:《中华神经外科杂志》2017年第4期334-338,共5页Chinese Journal of Neurosurgery

摘  要:目的评估慢性椎-基底动脉闭塞(VBAO)后介入开通技术的可行性、安全性和有效性,并总结慢性VBAO的侧支循环。方法回顾性分析2013年1月至2015年12月首都医科大学附属北京天坛医院介入神经病学科对13例慢性优势侧椎动脉颅内段和(或)基底动脉闭塞患者的临床资料。所有病例均进行介入开通治疗,分析开通率、侧支循环、围手术期并发症以及随访情况,比较手术前、后采用前向血流评定(TICI)分级和改良Rankin量表评分(mRS)评估患者的改善情况。结果13例患者中11例再通成功,TICI分级由术前的0级变为3级。3例患者术中置入1枚以上的支架,其中1例置入3枚,2例置入2枚。2例患者仅进行球囊扩张。本组1例患者出现围手术期并发症,MRI证实为穿支事件。在21个月的随访过程中,11例预后良好(mRS评分0~1分),1例预后中等(mRS评分2~3分),1例预后较差(mRS评分4~5分),无死亡患者。13例患者的慢性VBAO的侧支循环包括后交通动脉(8例)、小脑软膜动脉沟通(8例)、脊髓前动脉(3例)、大脑中动脉一大脑后动脉软膜动脉(2例)。结论对特定的症状性慢性VBAO患者,介入再通技术安全可行。但由于存在一定的围手术期并发症发生率,仍需进一步的临床研究。Objective To evaluate the technical feasibility, safety and long-term outcome of interventional reeanalization for chronic symptomatic intracranial vertebrobasilar artery occlusion (VBAO), and to summarize the collateral circulations for chronic VBAO. Methods A retrospective study was conducted about 13 consecutive patients with chronic VBAO on the dominant side who were admitted to Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University during the period from January of 2013 to December of 2015 and underwent interventional reeanalization. The rate of recanalization, collateral circulation, periprocedural complications and follow-up results were evaluated. The Thrombolysis in Cerebral Infarction (TICI) score was compared radiographically before and after procedure and the functional outcome was assessed based on the modified Rankin Scale (mRS). Results In this series, recanalization was successful in 11/13 patients immediately after the procedure. In 3 patients, more than 1 stent was applied because of the long lesions (3 stents in 1 patient and 2 stents in the other 2 patients). The balloon angioplasty only was conducted in 2 patients. One patient developed the perioperative complication of perforator stroke confirmed with MRI. At 21-month follow-up, 11 patients reported good outcome (mRS score: 0 -1). One patient had moderate (mRS socre: 2 -3) and one had poor outcome (mRS score: 4 -5). No death occurred. Collateral circulations for VBAO included posterior communicating artery (n = 8 ), cerebellar leptomeningeal artery ( n = 8), anterior spinal arteries ( n = 3) and leptomeningeal artery flow from middle cerebral artery to posterior cerebral artery (n = 2). Conclusion Endovascular recanalization for symptomatic chronic VBAO seems to demonstrate technical feasibility and safety for particular patients, which, however, needs further clinical research considering it may be associated with certain rates of perioperative complicat

关 键 词:椎底动脉供血不足 侧支循环 放射学 介入性 手术中并发症 

分 类 号:R743.3[医药卫生—神经病学与精神病学]

 

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