症状性颅外段椎动脉闭塞复合再通手术效果分析

Safety and efficacy of hybrid operation for symptomatic extracranial vertebral artery occlusion

目的探讨复合再通手术治疗症状性颅外段椎动脉闭塞(EVAO)的安全性和有效性。方法回顾性连续纳入2015年10月至2017年10月在首都医科大学宣武医院神经外科接受复合再通手术的EVAO患者11例。分析术前的血管造影资料获取闭塞的长度、对侧椎动脉状态以及侧支代偿情况。采用基于定量MR血管成像的无创优化血管分析(NOVA)技术来获取准确的基底动脉血流值。通过分析手术再通率、围术期并发症、术前及术后血流量的变化以及长期随访来探讨手术效果。结果11例患者中,10例血管再通成功,成功比率10/11;术后1例出现症状性小脑梗死,4例患者出现暂时性Horner综合征,6个月时均完全恢复,无脑出血、心肌梗死、术区血肿及死亡。NOVA显示,术后6个月基底动脉的血流量显著改善[术后比术前:(105±14)ml/min比(68±17)ml/min;t=3.285,P<0.05]。平均随访(30±10)个月,均无责任血管供血区新发缺血事件,仅1例出现轻度再狭窄。结论复合再通手术治疗症状性EVAO患者可能是安全有效的。

Objective To investigate the safety and efficacy of hybrid operation for symptomatic extracranial vertebral artery occlusion(EVAO).Methods A total of 11 symptomatic EVAO patients who underwent a hybrid operation in the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,were retrospectively recruited from October 2015 to October 2017.Angiograms were analyzed for occlusive length,contralateral vertebral artery(VA)status,and collaterals.Clinical variables,including 30-day outcomes and blood flow changes within 6 months based on quantitative magnetic resonance angiography(MRA)with noninvasive optimal vessel analysis(NOVA),were collected pre-and post-operatively.The effects of surgery were assessed according to the rate of recanalization,the rate of perioperative complications,the changes in blood flow before and after the operation,and the rate of long-term stroke recurrence.Results The vessel recanalization with hybrid technique was successful in all but one patient,the rate of successful recanalization was 10/11.One patient had new ischemic deficits within 7 days postoperatively.Four patients suffered from transient Horner syndrome postoperatively but recovered completely by 6-month follow-up.There were no perioperative cerebral hemorrhage,myocardial infarction,incision hematoma,and death.The blood flow in basilar artery improved significantly within6 months compared with the baseline blood flow(105±14 ml/min vs.68±17 ml/min,P<0.05).The mean follow-up period was 30±10 months.All revascularization was patent and no ischemic events recurred during follow-up.Only one patient was diagnosed as mild restenosis.Conclusion The hybrid technique is a potential safe and effective method to achieve recanalization and improve hemodynamic compromise for symptomatic EVAO.