锁骨下动脉狭窄合并椎动脉狭窄复发脑梗死1例

Recurrent Cerebral Infarction with Subclavian Artery Stenosis and Vertebral Artery Stenosis:a Case Report

目的探讨锁骨下动脉狭窄(SS)合并椎动脉狭窄(VAS)复发脑梗死的治疗方法。方法收集1例行支架开窗技术治疗的SS合并VAS复发性脑梗死患者的临床资料,比较术前术后影像学表现,同时进行文献复习。结果该患者术前脑血管造影示左锁骨下动脉中度狭窄合并左椎动脉开口重度狭窄,CT灌注成像(CTP)提示左侧部分脑区较对侧血流减少减慢,行血管支架置入术后左锁骨下动脉及左椎动脉起始段狭窄较前均明显改善,复查CTP示双侧脑区脑血流量、脑血容积相差不大,提示手术效果明显。结论支架开窗技术治疗SS合并VAS复发脑梗死患者,技术上可行,短期疗效尚可,但远期预后仍需要进一步随访。

Objective To explore the treatment of recurrent cerebral infarction with subclavian artery stenosis(SS)and vertebral artery stenosis(VAS).Methods Clinical data of a case of recurrent cerebral infarction with SS and VAS treated with stent fenestration were collected.The preoperative and postoperative imaging findings were compared,and the literature was reviewed.Results Preoperative cerebral angiography showed moderate stenosis of the left subclavian artery and severe stenosis of the left vertebral artery opening.CT perfusion(CTP)suggested that the blood flow in the left part of the brain was slower than that in the opposite side.The stenosis of the left subclavian artery and the initial segment of the left vertebral artery was significantly improved after stenting.CTP reexamination showed that there were no significant differences in cerebral blood flow and volume between the two sides of the brain,suggesting that the operation was obviously effective.Conclusion Stent fenestration is technically feasible and has acceptable short-term efficacy for the treatment of patients with recurrent cerebral infarction of SS and VAS,but the long-term prognosis still needs further follow-up.