腔内治疗起自主动脉弓的异位椎动脉狭窄:附5例患者的临床资料分析

Endovascular treatment for vertebral artery stenosis ectopic originating from aortic arch:clinical data analysis of 5 patients

目的总结异位起源于主动脉弓的椎动脉狭窄患者采用腔内治疗的可行性及效果。方法回顾性分析2020年1月至2023年5月期间首都医科大学宣武医院收治的5例异位起源于主动脉弓的椎动脉狭窄患者的治疗过程及结果。结果5例患者术前均行磁共振血管造影和CT血管造影检查,椎动脉均起自主动脉弓,均为重度狭窄,CT血管造影示病变直径1.1~1.5 mm、中位1.3 mm。5例患者均采用腔内治疗获得成功,手术时间为37~45 min、中位39 min。5例患者均未出现椎动脉破裂、栓塞或闭塞并发症,术中未发生脑梗死、斑块脱落,未见穿刺点血肿、假性动脉瘤及术后出血情况,围术期未见肺部感染病例。术后随访13~30个月、中位随访20个月,5例患者的血管均保持通畅,未发生临床意义的血管再狭窄情况。结论通过本组5例起源于主动脉弓的椎动脉狭窄患者的经验总结,对于椎动脉狭窄患者术前采用CT血管造影检查判断狭窄的程度,对于中重度有症状者采用腔内治疗是安全、有效的。

Objective To summarize the feasibility and effectiveness of endovascular treatment for vertebral artery stenosis ectopic originating from the aortic arch.Method The clinical data of 5 patients with vertebral artery stenosis ectopic originating from aortic arch admitted to Xuanwu Hospital of Capital Medical University from January 2020 to May 2023 were retrospectively analyzed.Results All 5 patients underwent magnetic resonance angiography and CT angiography before treatment.The vertebral arteries of all patients originated from the aortic arch and were severe stenosis,with a median diameter of 1.3 mm(range,1.1–1.5 mm)by CT angiography.All 5 patients were successfully treated with endovascular intervention.The operation time was 37–45 min,with a median of 39 min.There were no complications of vertebral artery rupture,embolism or occlusion,cerebral infarction,plaque abscission,hematoma at puncture site,pseudoaneurysm,postoperative hemorrhage,or perioperative pulmonary infection.The patients were followed-up for 13–30 months,with a median follow-up time of 20 months.The blood vessels of 5 patients remained unobstructed and no clinically significant vascular restenosis occurred.Conclusions Based on the experiences of 5 cases of vertebral artery stenosis ectopic originating from the aortic arch,it is safe and effective to choose endovascular treatment for severe symptomatic vertebral artery stenosis.Especially,it is necessary to evaluate the stenosis degree of vertebral artery using CT angiography before treatment.