症状性颅外段椎动脉长节段闭塞复合手术一例  

Hybrid operation for symptomatic long-segmental extracranial vertebral artery occlusion: a case report

作　　者：杨斌[1] 马妍[1] 焦力群[1] Yang Bin;Ma Yan;Jiao Liqun(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国脑血管病杂志》2019年第1期36-38,52,共4页Chinese Journal of Cerebrovascular Diseases

摘　　要：回顾性分析1例症状性颅外段椎动脉长节段闭塞且规范药物治疗期间仍有反复后循环缺血发作患者的临床及影像学资料,探讨复合手术治疗症状性颅外段椎动脉长节段闭塞的优势。患者为72岁男性,主要临床表现为发作性眩晕伴行走不稳。既往MRI检查示双侧小脑急性脑梗死,规范药物治疗期间仍有后循环缺血反复发作。本次入院DSA示右侧椎动脉V1至V2段闭塞,甲状颈干分支通过肌支血管代偿V2段及以远椎动脉血供,左侧椎动脉末端纤细; MRI无创优化血管分析提示右侧椎动脉V3段及基底动脉血流量明显低于正常值下限。患者于全身麻醉下接受右侧椎动脉闭塞复合再通术治疗后椎动脉再通,后循环血流改善。18个月随访期间血流通畅,症状无复发。结合文献复习认为对于药物治疗无效的症状性颅外段椎动脉长节段闭塞而言,复合手术结合了手术和介入的优势而能取得更优的治疗效果,可能是安全有效的治疗方式。A 72-year-old male patient who was diagnosed as symptomatic long-segmental extracranial vertebral artery occlusion suffered from recurrent posterior circulation ischemia even with medical therapy.Hybrid operation was performed and the vertebral artery was recanalized successfully.Postoperative non-invasive optimal vessel analysis showed the blood flow of vertebral artery and basilar artery improved significantly.Eighteen month follow-up examinations showed the vertebral artery was patent and no symptom recurred.Combined with literature review,we conclude that hybrid operation is considered to be a safe and effective treatment for symptomatic long-segmental extracranial vertebral artery occlusion patients who are refractoryto optimal medical therapy.

关 键 词：椎动脉 闭塞 症状性 复合手术 

分 类 号：R651.1[医药卫生—外科学]