双侧椎动脉/基底动脉重度狭窄或闭塞的急性后循环梗死患者临床特点及预后分析

Clinical features and prognosis of patients with acute posterior circulation infarction and severe stenosis or occlusion of both vertebral arteries/basilar artery

目的总结分析双侧椎动脉/基底动脉重度狭窄或闭塞的急性后循环梗死患者的临床特点和预后。方法收集急性后循环梗死且伴有双侧椎动脉/基底动脉重度狭窄或闭塞的住院患者资料,分析其血管危险因素、起始症状、治疗及病情演变情况,并随访90 d预后,以mRS>2分定义为预后不良。结果共纳入28例患者,最常见的起始症状为孤立性头晕或眩晕(57.1%)。53.6%的患者出现病情加重,加重≥2次9例(32.1%),预后不良15例(53.6%)。预后不良组高血压3级、病情加重、加重≥2次比例明显高于预后良好组(P<0.05)。病情加重≥2次组高血压3级、高脂血症、孤立性头晕或眩晕起病、预后不良和死亡比例明显高于加重<2次组(P<0.05)。基底动脉不显影组死亡率(75%)明显高于显影组(4.2%)(P<0.05)。结论双侧椎动脉/基底动脉重度狭窄或闭塞的急性后循环梗死患者多以孤立性头晕或眩晕起病;孤立性头晕或眩晕起病和高血压3级患者病情容易加重;病情反复加重患者预后不良比例高,死亡率高;基底动脉不显影患者死亡率高。

Objective To investigate the clinical features and prognosis of patients with acute posterior circulation infarction and severe stenosis or occlusion of both vertebral arteries/basilar artery. Methods A retrospective analysis was performed for the clinical data of patients with acute posterior circulation infarction and severe stenosis or occlusion of both vertebral arteries/basilar artery. The vascular risk factors, initial symptoms, treatment, and disease evolution were analyzed. The patients were followed up for 90 days, and a modified Rankin Scale score of 〉 2 was defined as poor prognosis. Results A total of 28 patients were enrolled, and the most common initial symptom was isolated dizziness or vertigo, which occurred in 57.1% of all patients. Of all patients, 53.6% experienced aggravation, and 9 （32.1%） had ≥2 times of aggravation; 15 （53.6%） had poor prognosis. Compared with the good prognosis group, the poor prognosis group had a significantly higher proportion of patients with grade 3 hypertension, aggravation, or ≥2 times of aggravation （P 〈 0.05）. Compared with the aggravation 〈 2 times group, the aggravation ≥2 times group had a significantly higher proportion of patients with grade 3 hypertension, hyperlipidemia, an initial symptom of isolated vertigo/dizziness, poor prognosis, or death （ P 〈 0.05 ）. The patients with no image of the basilar artery had a significantly higher mortality rate than those with the image of the basilar artery （75% vs 4.2%, P 〈 0.05）. Conclusions Patients with acute posterior circulation infarction and severe stenosis or occlusion of both vertebral arteries/basilar artery often have an initial symptom of isolated dizziness or vertigo. Patients with an initial symptom of isolated dizziness or vertigo and grade 3 hypertension tend to experience disease aggravation. Patients with frequent aggravation have a high proportion of patients with poor prognosis and a high mortality rate. Patients with no image of the basilar artery have a high mortality rate.