基底动脉闭塞的DSA分析

目的 探讨脑干梗死经DSA全脑血管造影证实基底动脉闭塞后的临床与预后，以期对临床治疗有一定的指导意义。方法 选取14例在临床中发现并经脑血管造影证实为基底动脉闭塞而临床症状轻微的患者。分析基底动脉闭塞后的临床表现与侧支代偿之间的关系。结果 （1）基底动脉近端闭塞，临床表现多以眩晕发作为主（占91％）；中段或远端闭塞，则多表现为间断性意识障碍（占66．7％）。（2）基底动脉近端闭塞，侧支血流多由颈外动脉和锁骨下动脉分支及椎动脉颅外段的肌支或脊髓前动脉代偿供血；基底动脉中、远段闭塞，侧支血流多由小脑后下动脉与小脑上动脉吻合（占100％）。结论 基底动脉闭塞若侧支代偿充分，可不表现明显的脑干缺血表现或表现轻微。内科治疗效果较好。     

大鼠脑干缺血模型制备及早期超微结构观察

目的:制备脑干缺血动物模型并观察大鼠脑干缺血后早期组织学病理的超微结构。方法:应用两点电凝基底动脉的方法制作鼠脑干缺血动物模型。结果:病理学观察发现脑干缺血2小时即可出现超早期病理变化,并随时间的延长缺血性损害逐渐加重。结论:两点电凝基底动脉后可以造成稳定的脑干缺血,对急性脑干缺血的病理学研究有一定的价值。     

椎基底动脉急、慢性闭塞腔内开通的初步经验

目的评价颅内段椎动脉、基底动脉闭塞腔内再开通的可行性、安全性及疗效。方法 11例优势椎动脉颅内段、基底动脉闭塞患者行腔内开通,记录分析术中各种并发症和相关危险因素,比较开通前、开通后及随访期间TIMI血流分级、mRS评分。结果 9例开通（成功率80%）,闭塞远端中位TIMI血流分级由术前的1级提升到术后的3级（P〈0.05）;中位mRS评分术前5分,术后48 h为5分,3个月随访为4分（P〉0.05）。1例椎动脉支架成形结合基底动脉接触溶栓并发颞叶出血,脑干新发梗死2例（其中1例术中基底动脉夹层,开通失败）,围手术期并发症总计3例、发生率27. 3%。亚组分析提示单纯椎动脉颅内段闭塞可能较基底动脉受累再开通率高、并发症少、临床预后较好。结论椎基底动脉闭塞腔内开通技术可行,术后血流分级和mRS评分有所改善,但鉴于其并发症发生率高、部分患者预后差,临床应严格筛选病例、谨慎开展。     

椎-基底动脉延长扩张症并脑干梗死3例的临床特点

目的 探讨椎-基底动脉延长扩张症(VBD)并脑干梗死的临床特点。方法 对3例椎-基底动脉延长扩张症并脑干梗死的临床资料进行回顾性分析,总结经颅多普勒(TCD)、CT动脉造影(CTA)及MRI观察其后循环血流动力学和影像学特征。结果(1)3例患者椎-基底动脉高度、位置偏移度及最宽直径的测量值均符合VBD的诊断标准;(2)TCD检查显示3例患者椎-基底动脉收缩期、舒张期峰值血流速度及平均血流速度降低;(3)头颈CTA显示椎-基底动脉不同程度的扩张、延长及迂曲,形成“S”形或“C”形;(4)头MRI显示急性脑梗死病变在延髓或中脑部位;(5)3例患者经抗血小板聚集、降脂等治疗后好转。结论 VBD合并脑干梗死可能存在椎-基底动脉形态和结构的变异及后循环血流动力学障碍。VBD常并发脑干梗死,对脑干梗死的治疗应依据患者临床表现和影像学特点采取个体化的治疗方案。     

大鼠基底动脉闭塞所致神经症状及缺血范围观察

目的:观察大鼠脑干缺血后的神经症状及缺血范围。方法:两点电凝大鼠基底动脉制作脑干缺血动物模型,应用亚甲兰和TTC(2,3,5-氯化三苯基四氮唑)染色确定缺血范围及程度。结果:两点电凝基底动脉后大鼠出现不同程度神经缺失症状。亚甲兰及TTC染色显示缺血区主要位于桥脑及延髓上部小部分区域。结论:两点电凝基底动脉后大鼠出现的神经功能障碍与临床脑干梗塞患者所出现的症状有相似之处,缺血部位恒定,可用来模拟某些临床病理过程。     

基底动脉弯曲和脑干梗死相关性研究

正本文就以基底动脉弯曲的形成机制及其与脑干梗死的关系研究进展作如下综述。一、基底动脉解剖及对脑干的血流供应颈内动脉系统和椎-基底动脉系统为脑部两大主要血管供应系统,其后者主要供应大脑半球后1/3、部分间脑、脑干及小脑,椎动脉由锁骨下动脉发出,颅后左、右椎动脉在桥延沟附近汇合而成基底动脉,在桥脑腹侧面向大脑半球的方向走形,基底动脉是后循环血管中最大最粗的动脉,亦为此供血区域的核心,且其直径自下至上逐渐变细,其走形可居     

脑干梗塞

1946年,Kubik 和 Adams 阐述了基底动脉闭塞的临床和病理。几十年来,各国学者经过观察、研究,不断补充了脑干梗塞的发病机理、病理生理改变及临床特征。本文仅就动脉硬化性脑干缺血性梗塞的临床表现和局部解剖关系,CT、MRI 脑干听觉诱发电位(BAEP)的诊断价值作一分析。     

新英格兰医学中心后循环登记

在407例新英格兰医学中心后循环登记患者中，59%为不伴TIA的卒中，24%在卒中前有TIA，16%仅表现为TIA。栓塞是最常见的卒中机制（占40%，其中24%为心源性栓塞，14%为动脉-动脉栓塞，2%两者兼有）。在32%的患者中，大动脉闭塞性损害导致血流动力学性脑缺血。梗死最常出现在后循环远段供血区（脑干腹侧、小脑上部以及枕叶和颞叶），近段（延髓和小脑后下部）和中段（桥脑和小脑前下部）供血区受累的比例相当。148例患者存在至少累及1支大动脉的重度闭塞性损害（狭窄〉50%），134例患者有单侧或双侧动脉受累。最常见的闭塞部位是椎动脉颅外段（52例患者，15例双侧）、椎动脉颅内段（40例患者，12例双侧）和基底动脉（46例患者）。动脉-动脉栓塞是椎动脉闭塞性疾病患者最常见的脑梗死发病机制。30d病死率为3.6%。发病机制为栓塞，远段供血区受累和基底动脉闭塞性疾病患者的预后最差。具有多处动脉狭窄部位的患者转归最好。他们通常经年累月地发生TIA。     

气囊闭塞和预防脑缺血药物在切除后颅窝 AVM 术中的应用

作者应用气囊导管闭塞基底动脉和AVM的供应血管及术前应用预防脑缺血的药物,成功地切除了一个大的后颅窝AVM。患者为14岁女孩,1983年9月30日突发头痛,继之眩晕、耳鸣、恶心和呕吐。CT扫描显示蛛网膜下腔出血且破入脑室,并有左侧小脑出血。一周后入院,检查除有左侧小脑体征外无其它神经功能缺失。常规和超选择性脑血管造影显示左侧小脑桥脑角有一大的AVM,其前上部由小脑上动脉供血,后下部由左小脑前下动脉供血。基底动脉耐受试验前给予20%甘露醇500ml,VitE300mg,地塞米松50mg,立即做气囊闭塞基底动脉耐受试验。15分钟后,无脑干症状,听觉诱发电位     

基底动脉阻塞对脑干传导功能的影响

基底动脉阻塞对脑干传导功能的影响赵士福，王东武，郑健，李黔宁体感诱发电位Ｐ１４成份（ＳＥＰ－Ｐ１４）及脑干听觉诱发电位（ＢＡＥＰ）可以反映内侧丘系及听觉通路的功能状态，本文观察１２例犬基底动脉（ＢＡ）上一点和两点阻塞２４小时内ＳＥＰ－Ｐ１４及ＢＡＥＰ...     

Internal carotid velocity measurements in children with cerebrovascular disease

Internal carotid artery flow velocity was evaluated by the Doppler ultrasound method in 32 children with cerebrovascular disease. The average maximal blood velocity (A/L) and end-diastolic blood velocity (d) were compared with each other as indices of blood flow velocity. The right and left mean A/L and d of moyamoya disease were significantly lower than those observed in normal children. The A/L and d of the affected side both in internal carotid artery occlusion and in middle cerebral artery occlusion were also significantly low. In the subarachnoid hemorrhage after rupture, these values were significantly low. In basilar artery occlusion, these values were similar to those in normal children. The results of this study indicate that Doppler ultrasound assessment of internal carotid flow velocity provides noninvasive reliable information for the diagnosis of cerebrovascular disease in childhood.     

Effect of diabetes mellitus on flow-mediated and endothelium-dependent dilatation of the rat basilar artery.

BACKGROUND AND PURPOSE: Diabetes mellitus may impair endothelium-dependent responses in cerebral arterioles. The basilar artery dilates in response to increases in blood flow. The goal of this study was to examine effects of diabetes mellitus on "flow-mediated" and endothelium-dependent dilatation of the basilar artery. METHODS: Diabetes was induced in rats with 50 mg/kg streptozotocin. Six months later, vessel diameter and velocity of blood flow through the basilar artery were measured using a cranial window in anesthetized rats under baseline conditions and during occlusion of the carotid arteries. Changes in vessel diameter were also measured during topical application of acetylcholine and sodium nitroprusside. RESULTS: With aortic pressure maintained at baseline levels, blood flow velocity through the basilar artery increased similarly in control and diabetic rats during unilateral common carotid artery occlusion and during bilateral occlusion. In control and diabetic rats, diameter of the basilar artery increased by 10 +/- 2% and 10 +/- 4% during unilateral occlusion and by 27 +/- 5% and 31 +/- 4% during bilateral occlusion, respectively. Thus, diabetes did not impair flow-mediated dilatation of the basilar artery. In contrast, dilatation in response to 10(-5) M topical acetylcholine was less in diabetic rats (13 +/- 2%) than in control rats (45 +/- 8%) (p less than 0.05). Dilator responses to nitroprusside were not impaired by diabetes. CONCLUSIONS: The findings suggest that diabetes produces impairment of endothelium-dependent responses to acetylcholine, but not flow-mediated dilatation, in the basilar artery.     

椎-基底动脉形态、血流量与脑干梗死的关系

目的研究椎-基底动脉形态、血流量与脑干梗死的关系。方法本研究分脑干梗死组与非脑干梗死组,用彩色多普勒超声分别测量两组患者椎动脉的血流量及管径,用颅脑MRA分别判定两组患者基底动脉弯曲度,通过统计分析,判定两组患者椎动脉血流量及管径、基底动脉弯曲度是否存在统计学差异。结果脑干梗死组双侧椎动脉血流量之和低于正常及一侧椎动脉管径低于正常时,与非脑干梗死组相比存在统计学差异。脑干梗死组基底动脉弯曲度分级与非脑干梗死组基底动脉弯曲度分级相比无统计学差别。结论脑干梗死与椎动脉形态、血流量相关,与基底动脉弯曲程度不相关。     

Basilar artery occlusion in rats

The basilar artery is one of the three major sources of blood supply to the circle of Willis. To investigate the effects of basilar artery occlusion, we surgically exposed and coagulated the basilar artery in 25 rats. Basilar artery occlusion at any single point between the foramen magnum and the circle of Willis in 11 rats did not produce histologically detectable infarcts in the brain at 12-24 hours. Two-point occlusions of the basilar artery in 12 rats produced variable infarcts between the occlusion sites but no ischemic lesions elsewhere. After either single- or double-point occlusions, the proximal basilar artery refilled within 2-3 minutes. When the basilar artery was occluded above and below the origins of the anterior inferior cerebellar arteries, the artery segments between the occlusion points initially collapsed but refilled within 2-3 minutes in two rats. Basilar artery occlusions invariably suppressed cortical somatosensory evoked potentials by greater than 50%. Regardless of whether a brain stem infarct developed, somatosensory evoked potential amplitudes recovered to greater than baseline levels by 4 hours in seven of 17 rats and returned to baseline levels by 24 hours in every rat tested. We conclude that the occluded basilar artery receives extensive retrograde collateral blood flow and that somatosensory evoked potentials are exquisitely sensitive to basilar artery occlusion but are insensitive to whether brain stem infarcts develop.     

Blood flow velocities in basilar artery during rotation of the head

The authors measured blood flow velocities with transcranial Doppler ultrasonography in the basilar artery after extreme rotations of the head. Studied subjects were divided in two groups according to the degree of asymmetry of the vertebral artery lumens. Rotation of the head caused significant reduction of the mean flow velocity in the basilar artery in the subjects with asymmetry of the vertebral arteries of more than 75%. The decline occurred only after the rotation ipsilaterally to the hypoplastic vertebral artery. This study confirms the importance of the collateral flow in the compensation of dynamic compression of the vertebral artery.     

''Herald hemiparesis'' of basilar artery occlusion: early recognition by transcranial Doppler ultrasound

A transient hemiparesis may be ocassionally present at an early stage of the thrombosis of the basilar artery (herald hemiparesis). We report on one of these cases and the valuable role of transcranial Doppler ultrasound (TCD) to the early detection of the stroke-in-evolution. TCD in the emergency room is a good tool to assess a basilar occlusion, searching for direct (absence of signal at the basilar artery) and indirect (reversal flow of the pre-communicating segment the of posterior cerebral artery through the posterior communicating artery) signs. Early recognition and treatment of this condition could avoid the development of the full syndrome of the basilar artery thrombosis.     

Pulsed Doppler assessment of innominate artery obstructive diseases

In 14 patients with severe stenosis or occlusion of the innominate artery a new high-energy, low-frequency (2 MHz) pulsed Doppler ultrasound method was used to investigate blood flow velocity patterns of both intrathoracic and intracranial cerebral arteries. Direct acquisition and evaluation of the innominate artery at its origin near the aortic arch enabled separation of it from adjacent arteries and reliable differentiation of stenosis from occlusion. Transcranial recordings from the basal cerebral arteries showed abnormal Doppler signals in 12 patients (86%). Among these abnormalities, observation of a latent steal phenomenon was closely related to the prevalence of cerebrovascular events. This latent steal phenomenon was characterized by a transient reduction of orthograde blood flow in the ipsilateral anterior, middle, and posterior cerebral arteries or in the basilar artery during postischemic hyperemia of the upper extremities. The predictive value of the latent steal phenomenon for the management and follow-up of asymptomatic patients with severe innominate artery obstructions is discussed.     

微血管多普勒监测下显微手术治疗基底动脉顶端动脉瘤（附10例报告）

目的总结基底动脉顶端动脉瘤的临床特征、手术入路和治疗效果。方法2007年1月至2011年12月在微血管多普勒监测下手术治疗基底动脉顶端动脉瘤10例,其中7例采取翼点入路和3例采取扩大翼点入路手术夹闭。结果10例患者共夹闭13个动脉瘤,切除2个动静脉畸形。9例恢复良好,1例术后1周自动出院后死亡。1例轻偏瘫患者于出院后4周恢复,2例出现动眼神经麻痹的患者均于出院后3个月内恢复。9例随访10个月-5年,均未见动脉瘤复发。结论显微手术是治疗基底动脉顶端动脉瘤重要手段。翼点入路和扩大翼点入路可以有效暴露动脉瘤。微血管多普勒在基底动脉顶端动脉瘤夹闭术中是一种直接、有效和便捷的监测方法。     

Early diagnosis of basilar artery occlusion using magnetic resonance imaging

Three patients with a clinical diagnosis of pontine infarction probably due to basilar artery occlusion were studied with magnetic resonance imaging within 24 hours after onset or latest progression of symptoms. The earliest changes on magnetic resonance images were an absence of signal void in the basilar artery suggestive of severe reduction of blood flow or occlusion (flow-void phenomena). The presumed basilar artery thrombosis was best demonstrated as a linear structure isointense or hyperintense with the brainstem in the pontine cistern on T1-weighted parasagittal images and as either absence of flow-void phenomena or higher signal intensity at various levels corresponding to the course of the basilar artery on the axial T2-weighted images. Brainstem parenchymal changes characteristic of infarction were not obvious for at least 12 hours after onset or 90 minutes after latest progression of symptoms and were best shown by both axial and coronal T2-weighted images. Recognition of these magnetic resonance imaging findings may allow earlier diagnosis and treatment of acute ischemia in the vertebrobasilar system.     

Preoperative risk assessment for carotid occlusion by transcranial Doppler ultrasound.

OBJECTIVES: An endovascular carotid balloon occlusion test with continuous intracranial monitoring by transcranial Doppler sonography was performed in 55 patients for prediction of tolerance of a required permanent occlusion of the carotid artery. METHODS: Blood flow velocities of the ipsilateral middle cerebral artery during occlusion were recorded and compared with clinical tolerance during an occlusion test as well as with postoperative outcome after an eventual permanent occlusion. To stress the capacity of the cerebral circulation to tolerate the occlusion acetazolamide was injected before occlusion in all patients. RESULTS: The onset of neurological symptoms during temporary occlusion was dependent on the percentage fall of mean blood flow velocity relative to baseline rather than on absolute flow velocities during the time of occlusion. Patients with a fall of mean flow velocity of less than 30% tolerated temporary and permanent occlusion, with the exception of two patients who developed an infarction due to thromboembolism after iatrogenic sacrifice of the carotid artery. Patients with a major decrease developed neurological symptoms during occlusion in 55% and, in cases of carotid ligation, a haemodynamic infarction occurred. CONCLUSION: The results show that transcranial Doppler monitoring as a part of an endovascular balloon occlusion test may be a reliable technique for preoperative risk assessment for permanent occlusion of the carotid artery.