药物或血管内介入治疗基底动脉闭塞/重度狭窄患者的侧支代偿模式  

Collateral circulation pathway in patients with basilar artery occlusion/severe stenosis:a single-center case series

作　　者：边洋 王鲲宇 苗妍 钟晓玲 贾爽爽 邱峰 Bian Yang;Wang Kunyu;Miao Yan;Zhong Xiaoling;Jia Shuangshuang;Qiu Feng(Department of Neurology,the Sixth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第六医学中心神经内科,北京100048

出　　处：《中华内科杂志》2021年第8期734-738,共5页Chinese Journal of Internal Medicine

基　　金：国家重点研发计划项目(2018YFA0108601);原海军总医院2018年度新业务新技术基金(HZXJS[2018]-10)。

摘　　要：目的:通过分析药物及血管内治疗基底动脉闭塞/重度狭窄预后良好患者的脑血流代偿特点,总结两种治疗患者的侧支代偿模式。方法:回顾性收集2019年1月至2020年1月解放军总医院第六医学中心神经内科收治的有后循环缺血症状且治疗后预后良好患者的病历资料,筛选出经过数字减影血管造影(DSA)证实的基底动脉闭塞/重度狭窄患者。依据住院时治疗方式不同分为强化药物治疗组(药物治疗组)与联合血管内治疗组(联合治疗组),通过对患者DSA中侧支代偿途径的描述,分析两组患者启动侧支代偿通路的多少及途径,总结两组患者侧支代偿模式特点,进一步探讨基底动脉闭塞/重度狭窄患者在选择治疗策略时评估侧支代偿模式的重要性。采用SPSS 22.0软件进行统计分析,计数资料采用构成比(%)进行统计描述。结果:共纳入符合条件患者32例,其中男性27例、女性5例,年龄45~76(59±10)岁。32例患者的代偿途径有:后交通动脉-大脑后动脉(13例,40.6%)、后交通动脉-大脑后动脉-基底动脉(10例,31.2%)、小脑后下动脉-小脑上动脉吻合支(8例,25.0%)、脉络膜前动脉-脉络膜后动脉吻合支(2例,6.2%)、未启动侧支循环(11例,34.4%)。其中药物治疗组多数存在侧支代偿(14/15例),且以后交通动脉代偿为主(10/14例);联合治疗组多数不存在侧支代偿(10/17例),且侧支循环途径以小脑后下动脉-小脑上动脉吻合支为主(6/7例)。结论:治疗基底动脉闭塞/重度狭窄的后循环缺血患者时,药物强化治疗侧支代偿较好的患者及联合血管内治疗侧支循环不良的患者均可取得较好的临床预后。Objective To investigate the collateral circulation compensation model in patients with favorable prognosis of basilar artery occlusion/severe stenosis treated with drugs or endovascular therapy.Methods Clinical data of patients with basilar artery occlusion/severe stenosis and good clinical outcome were retrospectively collected in the Department of Neurology,Sixth Medical Center of PLA General Hospital from January 2019 to January 2020.They were divided into intensive drug therapy group and combined endovascular therapy group.The number and ways of collateral compensation pathway described by digital substraction angiography(DSA)were analyzed,and the characteristics of the collateral compensation model were summarized.SPSS22.0 software was used for statistical analysis,and the constituent ratio(%)was used for statistical description of the enumeration data.Results A total of 32 eligible patients were included,including 27 males and 5 females,with an average age 45-76(59±10)years.The compensation model included posterior communicating artery-posterior cerebral artery(13 cases,40.6%),posterior communicating artery-posterior cerebral artery-basilar artery(10 cases,31.2%),cerebellar artery-anastomotic branches of superior cerebellar artery(8 cases,25.0%),anterior choroid artery-anastomotic branches of posterior choroid artery(2 cases,6.2%),collateral circulation not established(11 cases,34.4%).In drug treatment group,collateral compensation was found in the majority(14/15),with mainly posterior communicating artery(10/14).Most patients in combined treatment group did not develop collateral compensation(10/17),anastomotic branches of PICA-SCA were the main routes(6/7).Conclusion In patients with basilar artery occlusion/severe stenosis,favorable clinical outcome can be achieved in both groups of patients treated with intensive drug therapy or endovascular therapy.

关 键 词：基底动脉 椎底动脉供血不足 侧支循环 血流代偿 

分 类 号：R743.3[医药卫生—神经病学与精神病学]