摘要
目的 评价闭塞超过24 h的非急性期颅内椎基底动脉闭塞行腔内再通的可行性、安全性及中期疗效.方法 回顾性搜集行腔内支架成形或球囊扩张成形术开通的非急性期颅内椎基底动脉闭塞患者资料,根据闭塞是否累及基底动脉分为椎动脉闭塞组（15例）和基底动脉闭塞组（12例）,记录围手术期并发症、随访时再发事件短暂性脑缺血发作及卒中发生情况,使用非参数秩和检验比较手术前后改良Rankin量表（mRS）评分变化情况.结果 27例患者26例闭塞动脉（96.3％）成功开通.术后评估,13例患者病情改善,11例稳定,3例恶化.27例患者的中位mRS评分由术前的4分[四分位数范围（IR）,2～5分]恢复到出院时的3分（IR,1～5分）,差异有统计学意义（Z=3.116,P =0.002）.5例患者出现手术相关并发症,其中2例基底动脉夹层,1例术中支架内血栓形成,1例术中移位栓塞,1例术后急性闭塞.27例患者临床中位随访21个月,mRS为1分（IR,0～3分）,mRS≤2分患者的比例由术前的25.9％（7/27）提高到63.0％（17/27）.在此期间死亡3例,再发卒中1例,再发短暂性脑缺血发作2例.17例患者影像中位随访9个月（极值范围,5 ～ 30个月）,再发狭窄6例,其中3例为症状性.亚组分析显示：与各自术前mRS评分相比,出院时15例椎动脉闭塞组（Z=2.111,P=0.035）和12例基底动脉闭塞组（Z=2.333,P=0.020）患者的mRS评分改善均有统计学意义.结论 针对闭塞超过24 h的非急性期颅内椎基底动脉闭塞患者行腔内再通技术上是可行的,可以改善患者中期预后,但并发症及支架内再狭窄的发生率较高.
Objective To evaluate the technical feasibility,safety and mid-term effect of endovascular revascularization of nonacute intracranial vertebrobasilar artery occlusion.Methods Consecutive data of patients who suffered from nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours and underwent endovascular revascularization,were retrospectively collected and analyzed.Complications and recurrent events during the follow-up period were recorded.The modified Rankin scale （mRS） scores were used to compare the symptoms before and after the procedure.Results All 27 patients but 1 （96.3%） obtained successful recanalization.After the procedure,13 patients showed improvements,11 were stable,and 3 worse.The decline of median mRS scores,which was 4 [interquarter range（IR）,2-5） preoperatively and 3 （IR,1-5） on discharge,showed significant statistical difference （Z =3.116,P =0.002）.Five patients had procedural complications,namely 2 dissection,1 in-stent thrombosis during the operation,1 thrombus disruption and translocation during the operation and 1 acute reocclusion after operation.During the follow-up period with the median of 21 months,3 death,1 stroke and 2 transient ischemic attack occurred.The latest median mRS scores were 1 （IR,0-3）.The ratio of patients with mRS ≤ 2 increased from 25.9% （7/27） before operation to 63.0% （17/27） at the follow up.Seventeen patients received imaging follow-up during the 9 months,with restenosis in 6 and symptom in 3 of them.Subgroup analyses revealed better functional recovery （lower mRS） both in patients with vertebral artery occlusion （Z =2.111,P =0.035） and those with basilar artery occlusion （Z =2.333,P =0.020）.Conclusions Endovascular revascularization for the nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours is technically feasible,and improves disability recovery.However,the rates of procedural complication and restenosis are high.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2013年第12期1120-1123,共4页
Chinese Journal of Radiology
关键词
椎底动脉供血不足
放射学
介入性
Vertebrobasilar insufficiency
Radiology,interventional
