症状性椎动脉起始部重度狭窄/闭塞行椎动脉内膜切除术的疗效分析

Clinical analysis of severe narrowing/occlusion of symptomatic vertebral artery at the beginning of vertebral artery by endarterectomy

目的分析症状性椎动脉起始部重度狭窄或闭塞患者行椎动脉内膜切除术的手术疗效。方法收集潍坊市人民医院和胜利油田中心医院神经外科、重症医学科、脑卒中中心自2016年10月至2021年12月收治的33例行椎动脉内膜切除术患者的临床资料,所有患者均累及椎动脉起始部的症状性(6个月内发生短暂性脑缺血发作或非致残性卒中)的重度狭窄或闭塞,均经最佳药物治疗(双联抗血小板聚集药物联合他汀类降脂药物及危险因素控制)3个月以上,比较患者术前、术后椎动脉起始部管腔直径、神经功能缺损情况,统计患者术后并发症发生率及血管再狭窄发生率。结果33例患者的手术成功率为90.91%(30/33)。术后1周内出现声音嘶哑3例(9.09%)、霍纳综合征2例(6.06%)、乳糜漏1例(3.03%)、出血1例(3.03%)、急性脑梗死1例(3.03%)。33例患者术后起始部管腔直径较术前明显增大,美国国立卫生研究院卒中量表评分较术前明显降低,差异均有统计学意义(P<0.05)。结论椎动脉内膜剥脱手术治疗椎动脉起始部重度狭窄或闭塞安全有效。

Objective To analyze the curative effect of vertebral artery endarterectomy in patients with severe narrowing or occlusion of symptomatic vertebral artery initiation.Methods Clinical data of 33 patients with vertebral artery endarterectomy admitted to the Neurosurgery Department,Intensive Care Medicine Department,and Stroke Center of Weifang People's Hospital and Shengli Oilfield Central Hospital from October 2016 to December 2021 were collected.All patients with severe narrowing or occlusion involving the onset of the vertebral artery(transient ischemic attack or non-disabled stroke within 6 months)were treated with optimal medication(dual antiplatelet aggregation drugs combined with statin lipid-lowering drugs and risk factors)for more than 3 months.The diameter of the initial vertebral artery lumen and neurological deficits between patients before and after surgery were compared,and the incidence of postoperative complications and vascular restenosis were calculated.Results The surgical success rate of 33 patients was 90.91%(30/33).Within 1 week after surgery,there were 3 cases of hoarseness(9.09%),2 cases of Horner's syndrome(6.06%),1 case of chylous leakage(3.03%),1 case of bleeding(3.03%),and 1 case of acute cerebral infarction(3.03%).The initial lumen diameter of 33 patients increased significantly after surgery,and the National Institute of Health stroke scale score decreased significantly compared to preoperative,with statistical significance(P<0.05).Conclusion The treatment of severe stenosis or occlusion at the beginning of the vertebral artery with vertebral artery endarterectomy is safe and effective.