高分辨磁共振血管壁成像在症状性基底动脉狭窄血管内治疗中作用的初步探讨

Preliminary study of the role of high-resolution magnetic resonance vessel wall imaging in endovascular treatment of symptomatic basilar artery stenosis

目的初步探讨术前高分辨磁共振血管壁成像(HRMR-VWI)在症状性基底动脉重度狭窄血管内治疗中的应用价值。方法回顾性分析2019年4月至2020年4月首都医科大学附属北京安贞医院神经介入科连续收治的15例症状性基底动脉重度狭窄(狭窄率≥70%)患者的临床资料。术前所有患者均采用HRMR-VWI评估基底动脉狭窄处粥样斑块的位置、易损性及其与重要分支血管的关系。15例患者中,2例接受单纯球囊扩张术,13例行球囊扩张+支架成形术。评估围手术期并发症的发生率、病死率,通过临床随访明确随访期间的改良Rankin量表评分(mRS)、不良事件的发生率,通过影像学随访评估基底动脉有无再狭窄。结果15例患者术前的HRMR-VWI检查结果提示,动脉粥样斑块位于基底动脉背侧9例,腹侧2例,左侧壁7例,右侧壁6例。4例患者存在易损斑块表现。2例患者的动脉斑块毗邻左侧小脑前下动脉,5例位于基底动脉下段及双侧椎动脉汇合处。术中无一例发生基底动脉穿孔和下游血管栓塞。术后30 d内,1例患者发生1次短暂性脑缺血发作,15例患者均无出血性卒中和死亡事件。15例患者的中位随访时间为7.5个月(范围为5.0~9.0个月),无卒中及死亡事件,末次随访时mRS的中位数为1分(范围为0~1分)。8例患者术后6个月行影像学随访,其中1例患者发生基底动脉再狭窄(狭窄率为50%),其余7例行影像学复查未发现靶血管存在≥50%的再狭窄。结论初步研究结果表明,对于症状性基底动脉重度狭窄,HRMR-VWI可用于评估动脉狭窄处的斑块位置、易损性及其与重要分支血管的关系,有助于增加其血管内治疗的安全性。

Objective The aim of the study was to preliminarily determine the role of preoperative high-resolution magnetic resonance imaging vessel wall imaging(HRMR-VWI)in endovascular treatment of severe symptomatic basilar artery(BA)stenosis.Methods The clinical data of 15 patients with severe symptomatic BA stenosis(≥70%stenosis)who were admitted to Department of Neurointervention,Beijing Anzhen Hospital,Capital Medical University from April 2019 to April 2020 were retrospectively analyzed.All patients underwent HRMR-VWI prior to operation for assessment of the site of atherosclerotic plaques,vulnerability of plaques,and their relationship with major branch arteries.Among the 15 patients,2 cases underwent balloon dilatation alone and 13 cases underwent balloon dilatation combined with stenting.The perioperative complications,mortality,the modified Rankin Scale(mRS),and adverse events were clinically followed up.Restenosis of BA was assessed by imaging follow-up.Results The results of preoperative HRMR-VWI of 15 patients indicated that the atherosclerotic plaques were located on the dorsal side of BA in 9 cases,ventral side in 2,on the left-side wall in 7,and right-side wall in 6.Vulnerable plaques were identified in 4 cases.The atherosclerotic plaques were adjacent to the left anterior inferior cerebellar artery in 2 patients,and located at the lower segment of BA and the junction of bilateral vertebral arteries in 5 patients.Within 30 days post operation,1 transient ischemic attack was reported in 1 patient and no hemorrhagic stroke or death occurred in 15 patients.All 15 patients were clinically followed up for a median of 7.5 months(range:5.0-9.0 months)and there was no stroke or death.The median mRS score at the latest follow-up was 1 point(range:0-1 point).Eight patients underwent imaging follow-up at 6 months post operation,out of whom 1 patient reported the restenosis of 50%and 7 did not have the restenosis of≥50%.Conclusions This preliminary study has suggested that for the treatment of severe symptomatic BA stenosis,HRMR-VWI could be used to assess the location and vulnerability of stenotic plaques,as well as their relationship with major branch arteries.Moreover,it is helpful to increase the safety of endovascular treatment before operation.