急性串联型椎基底动脉闭塞伴对侧椎动脉闭塞或发育不良患者血管内开通策略  

Recanalization strategies for acute tandem vertebrobasilar artery occlusion with contralateral vertebral artery occlusion or dysplasia

作　　者：康周城 李德帅 李扬 魏东 师瑞 KANG Zhoucheng;LI Deshuai;LI Yang;WEI Dong;SHI Rui(Department of Neurology,First Affiliated Hospital of Air Force Medical University,Xi'an,Shaanxi Province 710032,China)

机构地区：[1]空军军医大学第一附属医院神经内科,陕西西安710032

出　　处：《介入放射学杂志》2023年第5期464-469,共6页Journal of Interventional Radiology

摘　　要：目的 探讨急性串联型椎基底动脉闭塞伴对侧椎动脉闭塞或发育不良患者血管内开通治疗策略。方法 回顾性分析2021年1月至12月在空军军医大学第一附属医院接受急诊血管内开通治疗的6例急性基底动脉闭塞伴双侧椎动脉闭塞或优势侧椎动脉闭塞且对侧椎动脉发育不良患者临床资料。根据病变类型和侧支循环条件差异,选择采用不同的开通治疗策略。结果 6例患者均为男性,中位年龄62.7岁。其中经颈深动脉逆向开通椎动脉1例,经颈升动脉逆向造影并在椎动脉闭塞远端滞留对比剂影指引下正向开通椎动脉1例,经优势侧正向开通椎动脉4例;随后均接受基底动脉取栓治疗。术后6例基底动脉改良溶栓治疗脑梗死(mTICI)血流分级达到2b/3,基底动脉开通成功率为6/6。术后3例患者因非手术因素死亡,其余3例改良Rankin量表(mRS)评分分别为0分、0分和3分,预后良好率为2/6。结论 对于急性串联型椎基底动脉闭塞伴对侧椎动脉闭塞或发育不良患者,积极的椎动脉正向或逆向再通术是治疗急性基底动脉闭塞的可行方法。Objective To discuss the endovascular recanalization strategies for acute tandem vertebrobasilar artery occlusion associated with contralateral vertebral artery occlusion or dysplasia.MethodsThe clinical data of 6 patients with acute basilar artery occlusion associated with bilateral vertebral artery occlusion or predominant lateral vertebral artery occlusion and contralateral vertebral artery dysplasia,who were admitted to the First Affiliated Hospital of Air Force Medical University of China between January and December of 2021,were retrospectively analyzed.According to the lesion's type and the collateral circulation features,different endovascular recanalization strategies were employed.Results All the 6 patients were males with a median age of 62.7 years.Of the 6 patients,retrograde recanalization of vertebral artery via deep carotid artery was performed in one,retrograde angiography via ascending carotid artery and anterograde recanalization of vertebral artery guided by"retained contrast agent"at the distal end of vertebral artery occlusion was accomplished in one,and anterograde recanalization of vertebral artery via the predominant artery was adopted in 4.Then,all the 6 patients received basilar artery thrombectomy.After treatment,the modified Thrombolysis in Cerebral Infarction(mTICI)grading of basilar artery was up to grade 2b/3,the success rate of basilar artery recanalization was 100%(6/6).Three patients died due to non-operative factors,and in other 3 patients the modified Rankin scale(mRS)score was O point,O point,and 3 points,respectively.The good prognosis rate was 33.3%(2/6).Conclusion For patients with acute tandem vertebrobasilar artery occlusion associated with contralateral vertebral artery occlusion or dysplasia,active anterograde or retrograde recanalization of vertebral artery is clinically feasible.

关 键 词：急性基底动脉闭塞 串联病变 正向开通 逆向开通 

分 类 号：R743.3[医药卫生—神经病学与精神病学]