症状性颅外椎动脉长段闭塞复合手术重建的短期临床观察

Short-term clinical observation of hybrid operation in symptomatic extracranial vertebral artery longsegment occlusion revascularization

目的评价复合手术在症状性颅外椎动脉长段闭塞患者血管重建中的安全性和有效性。方法收集2018年6月至2020年1月北京大学第三医院介入血管外科治疗的症状性颅外椎动脉长段闭塞患者5例,观察5例患者血管重建复合手术术前及术后神经系统评分,并评价神经功能的改善情况。结果5例患者椎动脉均成功开通,围手术期无并发症发生,无新发卒中或出血事件。其中病例1、病例3采用椎动脉内膜剥脱结合Fogarty取栓导管取栓术,病例2、病例4、病例5采用椎动脉内膜剥脱结合远端支架成形术。病例4在术后30 d复查时出现术侧椎动脉闭塞,但患者无症状,未予干预。结论复合手术可能是药物治疗不佳的症状性颅外椎动脉长段闭塞患者的一种可选的治疗方式,但术式以及支架的选择仍需进一步研究。

Objective To evaluate the safety and efficacy of hybrid operation in the revascularization in symptomatic extracranial vertebral artery long-segment occlusion.Methods From June 2018 to January 2020,five patients with symptomatic extracranial vertebral artery occlusion underwent hybrid operation revascularization in Peking University Third Hospital.The neurological score of 5 patients before and after operation was observed,and the neurological function of them was evaluated.Results 5 patients were revascularized successfully.There were no complications and no new-onset stroke or bleeding.For case 1 and case 3,endarterectomy combined with Fogarty catheter embolectomy was performed.For case 2,case 4,and case 5,endarterectomy combined with distal vertebral artery angioplasty and stenting was performed.In case 4,vertebral artery was occluded in one month follow-up,but the patient had no symptoms and no intervention was given.Conclusion Hybrid operation may be an alternative treatment for symptomatic long-segment occlusion of extracranial vertebral artery with poor drug treatment,but the choice of operation methods and stent still needs further study.