后循环缺血性卒中患者椎动脉病变特点及介入治疗临床观察

RELATIONSHIP BETWEEN VERTEBRAL ARERY AND ACUTE POSTERIORCIRCULATION INFARCTION ALONG WITH CLINICAL OBSERVATION OF INTERVENTIONAL RECANALIZATION

目的 探讨椎动脉病变与后循环缺血性性卒中的相关性及血管内介入治疗的临床有效性和安全性观察。方法 回顾性分析2019年1月—2021年6月在河北省唐山市人民医院行血管内介入检查及治疗的所有椎动脉病变患者的临床资料、手术记录及随访档案,分析椎动脉不同部位病变与后循环缺血卒中的相关性;采用美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS),评价患者治疗前后、随访期患者神经功能和残疾改善情况,同时记录围手术期并发症的发生率并分析其原因。结果 纳入研究椎动脉病变患者75例,其中V1病变12例,V2病变0例,V3病变2例,V4病变42例,串联病变19例。其中75例患者均行全脑血管造影检查,63例启动进一步血管内介入治疗,给予取栓、球囊扩张及支架等不同治疗方式,围手术期并发症16例,患者术后14 d及术后90 d的NIHSS评分及mRS评分均明显降低,与术前相比,差异有统计学意义(P<0.05)。结论 椎动脉V4段病变致后循环梗死发生率高,临床症状重,危害大,初期病变临床无症状或症状轻易被忽视;血管内介入治疗可降低后循环缺血性卒中风险,术后和随访期患者症状可得到改善,并发症需要引起重视。

Objective Relationship between the vertebral arery and acute posteriorcirculation infarction along with clinical observation of interventional recanalization.Methods From January 2019 to June 2021,the clinical data of patients with vertebral artery disease who were admitted to the Department of Stroke center of Tangshan People’s Hospital, were retrospectively analyzed.To investigate the correlation between the vertebral arery and acute posteriorcirculation infarction.The National Institutes of Health Stroke Scale(NIHSS) score and modified Rankin Scale(mRS) score were used to evaluate the improvements of neurological function and disability after treatment and during follow-up period, the complication and prognosis during perioperative and follow-up period were recorded.analyze the reasons of complication.Results Seventy-five Patients, there were 12 cases of V1,0 case of V2,2 cases of V3,42 cases of V4 and 19 cases of tandem lesions.Seventy-five Patients who were inspect with DSA,Sixty-three Patients who were treated with interventional recanalization treatment of Embolectomy, Balloon Dilatation and Stenting.Sixteen Patients who were appeared complication.The follow-up period was 14 days and 90 days.During the follow-up period, both the NIHSS score and the mRS score were significantly decreased when compared with preoperative data.Conclusion The high incidence of V4 segment who can be appeared acute posteriorcirculation infarction Severe clinical symptoms and great harm.This segment of lesion is easy to be ignored in clinical diagnosis and treatment, it that’s need to attention.For the treatment of acute posteriorcirculation infarction of vertebral arery, interventional recanalization therapy carries can reduce stroke risk, and the clinical symptoms can be reliably improved.We need to importance to the complication.