后循环短暂脑缺血发作的血管结构及临床结局

Analysis on the DSA and clinical events of TIA in posterior circulation

目的观察后循环短暂脑缺血发作患者数字减影主动脉弓及全脑血管造影显示的血管结构异常的类型、部位、数目并随访半年,观察其临床脑梗死事件的发生。方法观察对象为临床诊断为后循环短暂脑缺血发作性的患者,行数字减影主动脉弓及全脑血管造影检查,分析血管结构异常的类型、部位以及受累血管数目,分析后循环TIA患者半年内发生脑梗死的差异。结果后循环短暂脑缺血发作的患者86例,共有49(56.99%)例患者存在颈及颅内血管结构异常,其中单纯前循环病变10(11.63%)例;后循环病变39(45.36%)例,累及两条或两条以上血管的共20(24.19%)例,以椎动脉合并其他血管狭窄最为常见;其余37(43.01%)例造影未见血管结构异常;随访半年,16例颈及颅内血管结构异常的后循环TIA患者发生脑梗死,比对照组显著增高(P<0.01),NIHSS评分高于对照组,有5例治疗期间死亡。结论各种类型的血管形态异常是后循环短暂脑缺血发作的主要原因,颈动脉狭窄可能也是致病因素之一。数字减影血管造影是缺血性脑血管病安全准确的检查手段,颈及颅内血管结构异常的后循环TIA患者应积极采取临床干预。

Objective To analyze the results of digital subtraction angiography（DSA） and clinical events from 86 patients with transient ischemic attack（TIA） in posterior circulation. Methods DSA were pertormed in 86 patients with transient ischemic attack in posterior circulation. Seldinger technique were used,the 5F sheath was put into the right femoral artery after local anesthesia. All cases were put into two groups according to results of DSA,and observing clinical events in half one year. Results The abnormal rate of DSA was 56.99% ,in which pos- terior circulation involved was 45.36% ,and 11.63N cases only involved anterior circulationlafter 0.5 year＇s observation,20 in 49 cases of abnormal results of DSA suffered from cerebral infarction,and there was significant difference between the two groups. Conclusions DSA is valuable for analyzing mechanism of TIA in posterior circulation. We should take further measures for patients who have abnormal results of DSA.