摘要
目的 探讨基于高分辨率磁共振血管壁成像(HRMR-VWI)的“虚拟路途”导引下血管内再通术治疗慢性椎-基底动脉闭塞的可行性和有效性。方法 回顾性分析2023年5月至2024年5月采用血管内再通术治疗的5例慢性椎-基底动脉闭塞患者的临床资料。根据HRMR-VWI识别椎-基底动脉全程,并对闭塞段动脉进行重建,将MRA与CTA、DSA进行解剖匹配及影像融合,以融合后影像作为“虚拟路途”进行术中导引,将闭塞段动脉可视化,指导介入操作。结果 HRMR-VWI可清晰显示闭塞段动脉血管壁及管腔。融合影像的解剖位置准确,可全程显示目标血管闭塞段,并正确导引介入操作。5例均成功再通血管,术后即刻造影显示TICI分级2b级3例、3级2例。5例术后均无新发脑卒中相关并发症。5例术后随访3~12个月,没有新发神经功能障碍;3例复查造影显示再通血管维持通畅。术后3个月改良Rankin量表评分0分2例,1分3例。结论 HRMR-VWI与多模式影像融合可实现术中准确的三维影像可视化并引导介入操作,提高慢性椎-基底动脉闭塞再通术的成功率,减少并发症,改善患者的预后。
Objective To investigate the feasibility and effectiveness of endovascular recanalization for chronic vertebrobasilar artery occlusion under the guidance of a"virtual road map"based on high-resolution magnetic resonance vessel wall imaging(HRMR-VWI).Methods The clinical data of 5 patients with chronic vertebrobasilar artery occlusion who underwent endovascular recanalization between May 2023 and May 2024 were retrospectively analyzed.The entire vertebrobasilar artery was identified using HRMR-VWI,and the occluded arterial segment was reconstructed.Magnetic resonance angiography(MRA),computed tomography angiography(CTA),and digital subtraction angiography(DSA)images were anatomically aligned and fused.The fused images served as a"virtual road map"for intraoperative guidance,visualizing the occluded arterial segment to direct interventional procedures.Results HR-MRI vessel wall imaging clearly displayed the vessel wall and lumen of the occluded arterial segment.The fused images accurately represented anatomical locations,fully visualized the target occluded arterial segment,and effectively guided the interventional operations.Successful recanalization was achieved in all cases,with immediate post-procedural angiography showing TICI grade of 2b was achieved 3 cases and grade 3 in 2 cases.None of the patients experienced new stroke-related complications after the procedure.During the follow-up period of 3 to 12 months,no new neurological deficits were observed.Angiographic follow-up in 3 cases confirmed maintained patency of the recanalized vessels.Modified Rankin Scale(mRS)scores at three months post-operation were 0 in two cases and 1 in three cases.Conclusion HRMR-VWI combined with multimodal image fusion enables accurate three-dimensional visualization during surgery and guides interventional procedures,thereby improving the success rate of recanalization for chronic vertebrobasilar artery occlusion,reducing complications,and enhancing patient outcomes.
作者
林爱龙
汪志忠
陈迎春
尧小龙
李俊
LIN Ai-long;WANG Zhi-zhong;CHEN Ying-chun;YAO Xiao-long;LI Jun(Department of Neurosurgery,The Third People's Hospital of Hubei Province,Wuhan 430000,China)
出处
《中国临床神经外科杂志》
2025年第7期385-390,共6页
Chinese Journal of Clinical Neurosurgery
基金
湖北省卫生健康委员会项目(WJ2023M116
WJ2023M115)。
关键词
慢性椎-基底动脉闭塞
血管内再通术
HR-MRI血管壁成像
虚拟路途
Chronic vertebrobasilar artery occlusion
Endovascular recanalization
High-resolution magnetic resonance vessel wall imaging
Virtual road map
