复合手术治疗症状性颅内动脉狭窄合并近端血管迂曲病变二例  

Hybrid operation for symptomatic intracranial artery stenosis with proximal vascular tortuosity:report of two cases

作　　者：李龙[1] 杨斌[1] 陆夏[1] 马妍[1] Li Long;Yang Bin;Lu Xia;Ma Yan(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39-42,共4页Chinese Journal of Cerebrovascular Diseases

基　　金：北京市科技计划项目(D161100003816002)

摘　　要：分析2例经药物治疗无效的症状性颅内动脉重度狭窄合并近端血管迂曲患者的影像学特点及手术治疗经过,探讨通过复合手术改善或创造介入路径,同期行远端狭窄介入治疗的效果。患者1为73岁女性,症状性左侧大脑中动脉重度狭窄合并左侧颈内动脉起始段严重迂曲,规范药物治疗无效,行颈动脉血运重建+大脑中动脉支架置入复合手术后症状缓解。12个月随访期间血流通畅,症状无复发。患者2为70岁男性,症状性基底动脉狭窄合并左侧椎动脉起始段迂曲、右侧椎动脉V4段生理性纤细,规范药物治疗后仍有反复后循环缺血发作,行左侧椎动脉暴露+直视下穿刺椎动脉基底动脉支架置入复合手术,术后症状消失。9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、单纯介入治疗失败或难度较大的症状性颅内动脉狭窄合并近端血管严重迂曲的患者,复合手术可能是安全有效的治疗方式。Patient 1 was a 73-year-old female who was diagnosed as symptomatic severe stenosis of left middle cerebral artery with left internal carotid artery tortuosity. Her symptoms persisted despite the optimal medical therapy. Reconstruction of the left internal carotid artery was successfully performed by truncating the redundant segment and following end-to-end anastomosis,then intracranial stent was deployed via a new available approach. Patient’s symptoms alleviated after operation and never reoccured in 12-month follow-up. Patient 2 was a 70-year-old male who had basilar artery severe stenosis with left vertebral artery tortuosity and contralateral one slenderness. He suffered from recurrent posterior circulation ischemia even with optimal medical therapy. During the hybrid operation,the left vertebral artery was exposed and cut open so that an available approach for endovascular procedure was created. No recurrence of symptoms in followup after operation with for 9 months. Relevant literature was reviewed. We concluded that for treatment of symptomatic severe intracranial artery stenosis with proximal vascular tortuosity,hybrid operation can be safe and effective.

关 键 词：颅内动脉狭窄 颈动脉 椎动脉 迂曲 复合手术 

分 类 号：R651.1[医药卫生—外科学]