症状性椎⁃基底动脉重度狭窄或闭塞致后循环缺血性卒中的血管重建治疗  

Cerebral revascularization of symptomatic severe vertebro⁃basilar artery steno⁃occlusion with posterior circulation ischemic stroke

作　　者：李琪 孙杨 王本琳 佟小光[3] LI Qi;SUN Yang;WANG Ben-lin;TONG Xiao-guang(School of Medicine,Nankai University,Tianjin 300071,China;Clinical College of Neurology,Neurosurgery and Neurorehabilitation,Tianjin Medical University,Tianjin 300070,China;Department of Neurosurgery,Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]南开大学医学院,天津300071 [2]天津医科大学神经内外科及神经康复临床医学院,300070 [3]天津市环湖医院神经外科,300350

出　　处：《中国现代神经疾病杂志》2021年第7期553-561,共9页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：天津市科技计划项目(项目编号:18ZXDBSY00180)。

摘　　要：目的探讨慢性椎⁃基底动脉重度狭窄或闭塞致后循环缺血性卒中血管重建治疗的有效性和安全性。方法纳入2018年1月至2021年1月天津市环湖医院诊断与治疗的11例慢性椎⁃基底动脉重度狭窄或闭塞致后循环缺血性卒中患者,采用MRI定位梗死部位,CTA确定血管狭窄或闭塞部位以及狭窄率,DSA明确侧支代偿情况,分别行枕动脉⁃椎动脉(OA⁃VA)搭桥术、颈外动脉⁃桡动脉⁃椎动脉(ECA⁃RA⁃VA)搭桥术、枕动脉⁃小脑后下动脉/小脑前下动脉(OA⁃PICA/AICA)搭桥术、颞浅动脉⁃大脑后动脉/小脑上动脉(STA⁃PCA/SCA)搭桥术等后循环血管重建治疗,采用改良Rankin量表(mRS)评价预后。结果11例患者经CTA确定血管狭窄或闭塞部位,分别位于基底动脉占2/11,双侧椎动脉V4段⁃基底动脉串联病变占1/11,双侧椎动脉颅内段占2/11、颅外段占1/11,一侧椎动脉颅内段合并对侧颅外段占4/11,一侧椎动脉起始部闭塞合并另一侧椎动脉纤细占1/11。DSA明确侧支代偿情况,代偿血管分别为后交通动脉占7/11,小脑软膜吻合(包括小脑后下动脉、小脑前下动脉和小脑上动脉)占5/11,颈升动脉占4/11,大脑软膜吻合(大脑中动脉⁃大脑后动脉)占3/11,脊髓前动脉占1/11。11例患者顺利完成血管搭桥术,影像学检查(吲哚菁绿荧光血管造影术、DSA和CTA)均提示桥血管通畅。2例术后并发肺部感染,1例可疑颅内感染,均经抗生素治疗后好转。11例患者出院时mRS量表中位评分为1;术后平均随访8个月,9例预后良好(mRS评分为0~1)、2例预后中等(mRS评分为2~3)。结论血管重建治疗慢性椎⁃基底动脉重度狭窄或闭塞致后循环缺血性卒中有效性和安全性均较好,具备临床可行性。Objective To explore the efficacy and safety of cerebral revascularization treatment for the posterior circulation ischemic stroke with chronic vertebro⁃basilar artery steno⁃occlusion.Methods From January 2018 to January 2021,11 patients with posterior circulation ischemic stroke by chronic vertebro⁃basilar artery steno⁃occlusion were diagnosed and treated in Tianjin Huanhu Hospital.We utilized MRI to locate the infarct,CTA to assess the steno⁃occlusive site and the stenosis rate,and DSA to evaluate the collateral compensation.These patients were treated by using occipital artery(OA)⁃vertebral artery(VA)bypass,external carotid artery(ECA)⁃VA bypass with radial artery(RA)graft,OA⁃posterior inferior cerebellar artery(PICA)/anterior inferior cerebellar artery(AICA)bypass and superficial temporal artery(STA)⁃posterior cerebral artery(PCA)/superior cerebellar artery(SCA)bypass.The prognosis was assessed through modified Rankin Scale(mRS).Results The steno⁃occlusive sites confirmed by CTA were located at basilar artery(BA,2/11),bilateral vertebr⁃basilar artery as tander lesions(1/11),intracranial and extracranial segments of bilateral VA(2/11 and 11/11),unilateral intracranial segment of VA with contralateral extracranial segment of VA(4/11),initial segment of unilateral VA with tenderness of contralatieral VA(1/11).Collateral patterns confirmed by DSA included posterior communicating artery(PCoA,7/11),cerebellar pial collateral(5/11;among PICA,AICA and SCA),ascending cervical artery(AA,4/11),cerebral pial collateral[middle cerebral artery(MCA)⁃PCA,3/11]and anterior spinal artery(ASA,1/11).All the 11 patients underwent bypass operation successfully.Imaging[indoleocyanine green angiography(ICGA),DSA and CTA]suggested bypass vascular patency.Two patients suffered lung infection postoperatively,one patient was suspected with intracranial infection,and all the patients got better after antibiotic treatment.The median mRS score was 1.The mean follow⁃up time was 8 months.Nine patients had good progn

关 键 词：椎底动脉供血不足 卒中 脑缺血 脑血管重建术 脑血管造影术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]