基底动脉支架术后穿支闭塞3例报道

基底动脉是最易形成动脉硬化的血管之一[1-2].有资料表明,在后循环动脉狭窄中,基底动脉约占41.8％,由于基底动脉粥样硬化病变更为严重,侧支循环代偿差,较其他部位病变预后更差[3].因此,对于规范内科治疗无效的基底动脉狭窄患者,需要及时行介入治疗.     

Dysarthria during basilar artery balloon occlusion.

A 49-year-old woman presenting with recurrent, reversible brainstem symptoms and a distal basilar artery aneurysm underwent balloon test occlusion. Five minutes after balloon inflation she developed a reversible isolated dysarthria. Despite failing the test occlusion (and after an additional brainstem event), the patient underwent surgery with placement of a clip across the basilar artery. The operation was tolerated without complication. The authors conclude that 1) pure dysarthria may be a symptom of temporary basilar artery occlusion and 2) balloon testing may overestimate the risk of basilar artery clipping.     

Bilateral occlusion of basilar artery branches.

In a case in which the patient became totally paralysed except for blinking and vertical eye movements, microscopic serial sections of the pons showed bilateral infarcts which were due to occlusion of two small basilar branch arteries, one on each side. One basilar branch was occluded by an atheroma lying at its junction with the basilar artery and the other by an intramural dissection within the wall of the basilar artery. This case provides the clinico-pathological correlation for two further basilar branch infarcts. An unusual finding was that one of the branch arteries supplied the basis pontis and medulla bilaterally.     

Clinical features of proven basilar artery occlusion

Our study describes the early symptoms and signs of 85 patients with either basilar artery occlusion or bilateral distal vertebral artery occlusion documented by selective angiography. The most common prodromal symptoms were vertigo, nausea, and headache, which occurred during the 2 weeks before the stroke. Angiographic findings of 49 patients were classified into proximal, middle, and distal basilar artery occlusions. Twenty-two of these patients had additional vertebral artery lesions. A fourth group was composed of 36 patients with bilateral distal vertebral artery occlusion without opacification of the basilar artery through a vertebral artery injection. Onset was sudden in 20 patients; sudden, but preceded by prodromal symptoms in 11 patients; and progressive in 54 patients. Patients with progressive strokes often had bilateral vertebral artery occlusions. Most patients with acute onset had occlusion of the middle and distal basilar artery. An embolic origin of basilar artery occlusion from an arteriosclerotic vertebral artery lesion was assumed to be an important mechanism. An embolus reaching the basilar artery may not necessarily reach the top of the artery, but may also become lodged more proximally.     

The 'herald hemiparesis' of basilar artery occlusion

In thrombosis of the basilar artery, not infrequently a hemiparesis is present at an early stage, when brain-stem signs may be absent or few, slight or equivocal. It is natural to suspect that such a hemiparesis signifies localization in a cerebral hemisphere, but unexpectedly in a few hours bilateral hemiplegia appears associated with coma or a locked-in syndrome, indicating basilar artery occlusion. I would term this disarming hemiparesis the "herald hemiparesis" of basilar artery occlusion. If the true nature of the condition is recognized early, the use of heparin and other measures may forestall disaster.     

Magnetic resonance imaging in basilar artery occlusion

CONTEXT: Acute basilar artery occlusion has particularly high mortality and morbidity. OBJECTIVE: To determine the potential utility of advanced magnetic resonance imaging (MRI) methods, including diffusion-weighted imaging, for the early management of patients with basilar artery thrombosis. DESIGN: Case series. SETTING: Institute of Neuroradiology and Department of Neurology, Johann Wolfgang Goethe University, Frankfurt, Germany. PATIENTS: In 4 patients with occlusion of the basilar artery, MRI was performed, including T2-weighted and diffusion-weighted imaging (DWI) sequences and magnetic resonance angiography (MRA) in the short-term phase (<12 hours). Three patients underwent intra-arterial thrombolysis. Clinical outcome was obtained 10 days after symptom onset. RESULTS: The MRA was performed 3.5 to 11.5 hours after symptom onset and showed basilar artery occlusion in all cases. The DWI revealed different patterns of ischemic lesions. In 2 patients, no or only small lesions could be identified; the remaining showed multiple and large lesions within the posterior circulation territory. Initial clinical status was severely impaired in all cases (Rankin scale score, 4-5). Thrombolysis was initiated in 3 patients, leading to successful recanalization in 2. Clinical outcome was favorable in the 2 patients with small DWI lesions and successful reperfusion (Rankin scale score, 2), whereas it was worse in those with large DWI lesions and persisting occlusion (death, persisting coma). CONCLUSIONS: In critically ill patients with acute basilar occlusion, the extent of DWI lesion involvement can be highly variable. Small DWI lesions seem to be associated with a favorable outcome if reperfusion is achieved with thrombolysis. This could potentially be the case independent of time from symptom onset.     

Endovascular embolectomy of acute basilar artery occlusion

Acute basilar artery occlusion has a mortality rate approaching 90%. The authors describe a case of acute basilar artery occlusion managed successfully with endovascular embolectomy. A 31-year-old man sought treatment for confusion, dysarthria, and right-sided weakness. He soon became unresponsive and was found to have a vertebral artery dissection and an associated basilar artery embolism. The dissection was managed with endovascular stenting, and the basilar artery embolus was removed with a clot retriever at 7 hours. The patient recovered without neurologic deficit.     

Thrombolytic treatment for acute occlusion of the basilar artery.

Sixteen patients with acute occlusion of the basilar artery were treated with systemic fibrinolysis. Recanalisation was achieved in 10 patients; five patients survived and 11 patients died. Survival was associated with vascular recanalisation in every case. Most of the survivors were younger than 50. An age above 50 and a comatose state on admission seem to indicate a poor clinical outcome. The problem of multimorbidity in the older age group also affects outcome adversely. Haemorrhagic complications were found in two cases (12.5%), with clinical deterioration in one.     

基底动脉末段动脉瘤术中基底动脉的临时阻断

目的探讨基底动脉末段动脉瘤显微外科术中采用基底动脉临时阻断(TBAO)的可行性.方法回顾性分析892例基底动脉末段(基底动脉分叉部和基底动脉-小脑上动脉)非巨大动脉瘤显微外科术中采用TBAO与非TBAO的疗效并进行比较.结果单次阻断不超过5 min比较安全,超时或重复阻断则病残和死亡率增加;TBAO应慎重地用于术前不良分级、老年和多发性动脉瘤的患者,阻断的同期使用低血压(平均动脉压<70 mmHg)应视为禁忌.结论基底动脉动脉瘤早期外科治疗中采用TBAO较非TBAO疗效好.