症状性椎-基底动脉闭塞非急性期血管内再通治疗的临床疗效

Clinical efficacy of endovascular recanalization therapy in symptomatic vertebrobasilar artery occlusion in the non-acute phase

目的初步观察症状性动脉粥样硬化性椎-基底动脉闭塞(VBO)非急性期血管内再通治疗的临床疗效.方法回顾性分析2019年1月至2020年12月郑州大学人民医院脑血管病介入治疗中心采用血管内治疗的58例非急性期症状性动脉粥样硬化性VBO患者的临床资料.术前改良Rankin量表评分(mRS)0~2分50例,3~4分8例.观察血管的再通情况、围手术期并发症及术后随访结果.结果58例患者中,48例(82.8%)血管再通成功,术后即刻造影显示,脑梗死溶栓分级3级者26例(54.2%),2b级者22例(45.8%).10例(17.2%)因微导丝无法通过闭塞节段而放弃治疗.再通成功的48例患者中,围手术期2例(4.2%)发生缺血性卒中,其中1例MRI发现新发梗死灶;1例(2.1%)发生脑出血.10例再通未成功的患者均未发生手术相关并发症.术后3~6个月随访,48例再通成功的患者,数字减影血管造影显示2例(4.2%)发生支架内闭塞(均为围手术期发生缺血性卒中者);6例(12.5%)支架内再狭窄,但均无临床症状.47例(97.9%)患者mRS为0~2分,1例支架内闭塞再发脑梗死患者的mRS为4分.10例再通失败者均采取药物治疗,均有缺血性卒中症状,2例症状加重.结论非急性期血管内治疗动脉粥样硬化性VBO患者的血管再通成功率较高、手术相关并发症的发生率较低,短期临床疗效较好.

Objective To preliminary investigate the elinical efficacy of non-acute endovascular recanalization therapy for symptomatic atherosclerotic vertebrobasilar artery occlusion(VB0).Methods A retrospective analysis was conducted on the climical data of 58 patients with non-acute symptomatic atherosclerotic VBO who underwent endovascular surgery at the Department of Cerebrovascular Diseases,People's Hospital of Zhengzhou University from January 2019 to December 2020.Preoperative assessment using the modified Rankin scale(mRS)showed 0-2 in 50 cases and 3-4 in 8 cases.Vascular recanalization,perioperative complications,and postoperative follow-up results were documented.Results Among the 58 patients,48(82.8%)had successful vascular recanalization,and immediate postoperative angiography showed that 26(54.2%)were grade 3 and 22(45.8%)were grade 2b based on the modified thrombolysis in cerebral infarction(mTICI)scale.Ten patients(17.2%)failed to finish the treatment because the microguide wire could not pass through the occluded segment.Among the 48 patients who successfully underwent recanalization,2(4.2%)had ischemic stroke perioperatively,and 1 of them showed a new infarct on MRI;1 case(2.1%)developed cerebral hemorrhage.None of the 10 patients who had unsuccessful recanalization developed surgery-related complications.At 3-6 months post surgery and among 48 patients with successful recanalization,DSA showed that 2 cases(4.2%)developed stent occlusion(both reported perioperative ischemic stroke);6 cases(12.5%)had restenosis in the stent,but none were clinically symptomatic.The mRS score was0-2 in 47 patients(97.9%)and and4 in 1 patient who developed recurrent cerebral infarction due to stent occlusion.All 10 patients who failed to undergo recanalization were treated with medication,all had symptoms of ischemic stroke,and 2 cases had worsening symptoms.Conclusions Patients with non-acute atherosclerotic VBO have a higher success rate of vascular recanalization,a lower incidence of surgery-related complications,and a relatively good short-term clinical outcome.