椎动脉颅内段急性闭塞伴与不伴基底动脉栓塞的对比研究  

Comparative study of acute intracranial vertebral artery occlusion with and without basilar artery embolism

作　　者：张洋 王丽娜 朱良付 马振凯 周腾飞 周志龙 管民 吴立恒 李天晓 Zhang Yang;Wang Lina;Zhu Liangfu;Ma Zhenkai;Zhou Tengfei;Zhou Zhilong;Guan Min;Wu Liheng;Li Tianxiao(Department of Cerebrovascular Diseases,People′s Hospital of Zhengzhou University,Henan Provincial People′s Hospital,National Advanced Stroke Center,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院(河南省人民医院)脑血管病科,国家高级卒中中心,郑州450003

出　　处：《中华神经外科杂志》2023年第3期269-273,共5页Chinese Journal of Neurosurgery

基　　金：中国脑卒中高危人群干预适宜技术研究及推广项目(GN-2018R0007)。

摘　　要：目的对比分析动脉粥样硬化性椎动脉颅内段急性闭塞(ICAD-AIVAO)伴与不伴基底动脉栓塞患者的临床特点及治疗效果。方法前瞻性纳入2017年2月至2021年6月就诊于河南省人民医院脑血管病科并于发病24 h内接受急诊血管内治疗的ICAD-AIVAO患者,收集患者的临床、影像学、治疗及随访资料。所有患者的AIVAO均由动脉粥样硬化原位血栓形成(ISAT)所致,根据是否伴有动脉到动脉栓塞累及基底动脉,将患者分为ISAT组和ISAT+基底动脉栓塞组。比较两组患者的基线资料、治疗情况及预后。结果共纳入52例患者,男性占90.4%(47/52),进展型起病占57.7%(30/52)。与ISAT组(32例)比较,ISAT+基底动脉栓塞组(20例)术前基于弥散加权成像(DWI)的后循环Alberta卒中项目早期CT评分(DWI-pc-ASPECTS)和基底动脉CT血管成像(BATMAN)评分低,脑桥中脑指数高,中脑梗死、脑干梗死者的占比均更高(均P<0.05)。ISAT+基底动脉栓塞组机械取栓次数较ISAT组多[M(Q1,Q3)分别为2(1,2)次、1(0,2)次,P=0.030]。ISAT+基底动脉栓塞组的完全再灌注率较ISAT组高[75.0%(15/20)对比46.9%(15/32),P=0.046];但两组成功再灌注率、术后90 d功能独立率、90 d预后良好率及90 d病死率的差异均无统计学意义(均P>0.05)。围手术期,两组发生血管夹层、栓子逃逸、术后7 d内症状性颅内出血的差异均无统计学意义(均P>0.05)。结论与不伴基底动脉栓塞患者比较,伴基底动脉栓塞的ICAD-AIVAO患者脑干梗死、术中机械取栓次数更多,完全再灌注率更高,但未观察到围手术期并发症及预后的差异。Objective To compare the clinical characteristics and treatment effects of patients with acute intracranial vertebral artery occlusion complicated with underlying intracranial atherosclerotic disease(ICAD-AIVAO)with and without basilar artery embolism.Methods We prospectively included ICAD-AIVAO patients who underwent emergency endovascular treatment within 24 hours from the onset at the Department of Cerebrovascular Diseases,Henan Provincial People′s Hospital from February 2017 to June 2021 and collected their clinical,imaging,treatment,as well as follow-up data.All patients with AIVAO were caused by in situ atherosclerotic thrombosis(ISAT).The patients were divided into the ISAT group and the ISAT with basilar artery embolism group according to whether there was artery-to-artery embolism involving the basilar artery.The baseline data,treatment and outcomes of the two groups were compared.Results A total of 52 patients were enrolled.Males accounted for 90.4%(47/52),and progressive onset accounted for 57.7%(30/52).Compared with the ISAT group(32 cases),the ISAT with basilar artery embolism group(20 cases)had lower preoperative DWI-based posterior circulation Alberta stroke program early computed tomography score(DWI-pc-ASPECTS)and basilar artery on computed tomography angiography(BATMAN)score,higher pons midbrain index(PMI),and higher incidence of brainstem infarction and midbrain infarction(all P<0.05).The number of mechanical thrombectomy in the ISAT with basilar artery embolism group was higher than that in the ISAT group[M(Q1,Q3):2(1,2)vs.1(0,2),P=0.030].The complete reperfusion rate in the ISAT with basilar artery embolism group was higher than that in the ISAT group[75.0%(15/20)vs.46.9%(15/32),P=0.046].However,there was no significant difference in the successful reperfusion rate,90-day functional independence rate,90-day good outcome rate,and 90-day mortality between the two groups(all P>0.05).During perioperative period,there was no significant difference in the dissection,embolic escape,and sICH(sympto

关 键 词：动脉闭塞性疾病 椎动脉 动脉粥样硬化 血管内操作 对比研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学]