症状性椎动脉颅内段非急性闭塞血管内再通治疗的可行性和安全性  

The initial experience of endovascular recanalization for non-acute symptomatic intracranial vertebral artery occlusion

作　　者：夏金超 林枫 冯光 白卫星 朱良付 薛绛宇 李天晓 王子亮 Xia Jinchao;Lin Feng;Feng Guang;Bai Weixing;Zhu Liangfu;Xue Jiangyu;Li Tianxiao;Wang Ziliang(Department of Interventional Neurology,People Hospital of Zhengzhou University,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,郑州450003

出　　处：《中华放射学杂志》2024年第12期1437-1443,共7页Chinese Journal of Radiology

摘　　要：目的通过分析和报告症状性椎动脉颅内段非急性闭塞的血管内再通治疗的单中心临床经验,以评估该病血管内再通治疗的可行性和安全性,并提出患者筛选受益分组。方法回顾性分析2019年1月至2021年12月郑州大学人民医院行血管内再通术的92例椎动脉颅内段非急性闭塞伴有进展性或复发性缺血症状的患者,根据患者闭塞长度、闭塞时间、斑块性质、闭塞部位是否钙化及闭塞节段成角将其分为低、中、高风险3组,分析各组患者的一般基线资料、手术情况及随访结果,计算低、中、高风险组的手术成功率及并发症发生率,并使用χ2检验或方差分析来评估3组之间的统计学差异。结果血管内再通的总体技术成功率为83.7%(77/92),围手术期并发症发生率为10.9%(10/92)。在3个分组中,再通成功率从低风险组至高风险组分别为100%、93.3%和27.8%,逐渐降低,差异具有统计学意义(P=0.047);而围手术期总体并发症发生率则分别为0、10.0%和38.9%,逐渐升高,差异具有统计学意义(P=0.001);90 d mRS评分0~2分占比分别为100%、83.3%和22.2%,逐渐降低,差异具有统计学意义(P=0.026);再通成功的77例患者随访再狭窄/再闭塞率分别为0、17.9%和80.0%,逐渐升高。低风险组和中风险组患者对血管内再通表现良好,88例患者(4例患者失访)的中位临床随访期为13(7,16)个月,30 d后的卒中或死亡率为17.4%(16/92)。结论对于合理选择的症状性椎动脉颅内段非急性期闭塞患者,血管内再通术是安全可行的,尤其是低风险组和中风险组患者;并对于非急性椎动脉颅内段闭塞伴有进行性或复发性缺血症状的患者提供了除积极药物治疗外的另一种选择。Objective To report single-center clinical experience with endovascular recanalization for non-acute symptomatic intracranial vertebral artery occlusion,to assess the feasibility and safety of endovascular recanalization and to propose the benefit group for selected patients.Methods From January 2019 to December 2021,92 patients with non-acute symptomatic intracranial vertebral artery occlusion who underwent endovascular recanalization were retrospectively analyzed.The patients were divided into three groups(low,medium and high-risk group)according to occlusion length,occlusion duration,occlusion nature,calcification of the occlusion segment,and occlusion angulation,and the indicators of patients in each group were analyzed,including the general baseline data of the patients,surgical status and follow-up results.The technical success and perioperative complication rates of low,medium and high-risk groups were calculated.Meanwhile,the differences between three groups were evaluated using the χ^(2) test for trend or ANOVA analysis.Results The overall technical success rate of endovascular recanalization was 83.7%(77/92),and the perioperative complication rate was 10.9%(10/92).Among the 3 classification groups,the recanalization success rate from the low-risk group to the high-risk group was 100%,93.3%,27.8%(P=0.047),and gradually decreased;while the overall perioperative complication rate was 0,10.0%,38.9%(P=0.001),and gradually increased;the proportion of 90-day mRS score 0-2 was 100%,83.3%,22.2%(P=0.026),and progressively decreased;77 patients with successful recanalization were followed up,the rate of restenosis/reocclusion was 0,17.9%,80.0%(P=0.001),and progressively increased.Patients in the low-and intermediate-risk groups performed well with endovascular recanalization.In 88 patients(4 patients lost to follow-up),a median clinical follow-up of 13(7,16)months,stroke or death beyond 30 days was 17.4%(16/92).Conclusions Endovascular recanalization is safe and feasible for reasonably selected patients with non-

关 键 词：椎动脉 闭塞开通 颅内段 非急性期 

分 类 号：R743[医药卫生—神经病学与精神病学]