胰液膀胱引流式胰肾联合移植长期存活15例随访

背景：胰肾联合移植是治疗1型糖尿病合并终末期肾病的首选疗法,但由于移植风险高,并发症多,国内开展并不广泛。 目的：总结胰液膀胱引流式胰肾联合移植长期存活的临床经验,观察其远期效果并分析影响因素。 方法：对15例患者行胰液膀胱引流式胰肾联合移植,均采用心脏死亡的供体。HLA配型平均为2.13。均选择胰液膀胱引流式和体循环回流血管吻合方式,免疫抑制剂方案均用他克莫司,霉酚酸酯和泼尼松治疗。观察移植后患者移植物肾功能、血糖、淀粉酶等及并发症。 结果与结论：最短随访8.5个月,最长随访105.5个月,平均住院时间为37.7 (13~82) d。移植后13例患者胰腺功能恢复,2例于移植后即切除移植胰腺。移植后除1例患者肾脏功能延迟恢复外,其余患者肾脏功能立即恢复。2例患者因慢性排斥反应丢失移植胰腺和移植肾。移植后主要并发症为排斥反应,返流性胰腺炎和血栓形成。提示胰肾联合移植是治疗终末期糖尿病并发肾功能衰竭的一种安全而有效地治疗方法,其远期效果理想,完善的围移植期管理、预防和及时处理并发症、合理应用免疫抑制剂是影响患者和移植物长期存活的重要因素。     

磁共振检查对基底动脉血栓形成患者的诊断价值

目的了解磁共振检查对基底动脉血栓形成患者的诊断价值。方法17例经证实为基底动脉血栓形成的患者于发病后48h时内接受磁共振T2加权成像、磁共振血管成像、弥散加权成像检查。结果所有患者都在磁共振血管成像上可见基底动脉血流信号消失和一侧或双侧椎动脉血流信号消失；弥散加权成像可见后循环区域不同形态散在分布的多发梗死灶；T2 成像可发现基底动脉内血栓形成。结论磁共振血管成像检查对颅内血管闭塞有较高的敏感性，弥散加权成像对后循环供血区域梗死灶的诊断能力优于传统影像学检查。     

同一机构5年原位肝移植726例术后并发肝动脉血栓形成14例资料回顾

背景：虽然肝移植技术已经成熟,但肝动脉血栓形成仍是造成肝移植后移植物丢失的重要原因之一,肝动脉血栓形成如果不能及早发现处理,只有再次肝移植才能挽救患者生命。 目的：总结原位肝移植后并发肝动脉血栓形成的治疗体会。 方法：中山大学附属第一医院器官移植中心从2004-01/2009-12共实施726例成人尸肝移植,共14例患者经造影证实在肝移植后出现肝动脉血栓形成,回顾性分析以上14例患者的临床资料。 结果与结论：肝动脉血栓形成的发生率为1.9%(14/726),发生的平均时间为移植后10 d(1~41 d)。14例肝动脉血栓形成患者中,6例表现为急性的肝功能恶化,4例表现为胆漏,1例表现为肝脓肿,3例无明显临床症状。3例行急诊肝动脉再血管化,2例行肝动脉溶栓治疗,3例行肝动脉再血管化联合肝动脉局溶栓治疗,6例行再次肝移植。本组肝动脉血栓形成相关的死亡率为42.9%(6/14),其中2例行肝动脉再血管化后因胆道坏死、肝功能衰竭死亡;1例溶栓后再次血栓形成并发多器官功能衰竭死亡;1例肝动脉再血管化联合肝动脉溶栓后因肾功能衰竭、严重感染死亡;2例再次移植后早期因严重感染死亡。8例患者康复出院,并常规随访18~66个月,其中2例患者分别于肝移植后18,29个月因肝癌复发死亡,以上患者随访过程中移植肝功能正常,肝动脉畅通。提示肝动脉血栓形成是肝移植后的严重并发症,在造成不可逆的胆道和肝实质损伤前,尽早恢复肝动脉血流可以避免再次肝移植。     

老年人脑膜瘤的脑血管造影及术前栓塞治疗

目的探讨脑血管造影对老年人脑膜瘤的价值及术前栓塞的临床效果。方法选择60岁以上的脑膜瘤17例行全脑血管造影，对单纯颈外动脉供血和颈外动脉为主要参与供血者进行血管内栓塞。结果17例60岁以上的脑膜瘤患者，经血管造影显示肿瘤以颈内动脉供血为主和单纯颈内动脉供血者5例；单纯颈外动脉和以颈外动脉供血为主者12例。后者经颈外动脉分支用250—350μm明胶海绵颗粒栓塞剂实施栓塞，肿瘤染色完全消失7例，大部消失5例。无栓塞相关并发症。栓塞后2～7d手术，肿瘤全切10例，次全切除2例，栓塞后肿瘤出血明显减少，平均输血量400ml。结论脑血管造影及术前栓塞对老年脑膜瘤患者是一种安全、有效的检查和辅助治疗措施，可明显减少手术中出血量、缩短手术时间和减少并发症。     

磁共振三维血管成像技术评估股骨颈骨折股骨头血运状态

背景：国内外临床上判断股骨颈骨折后股骨头局部血运的方法较多，但使用时缺点较多，尤其是不能准确判断股骨颈骨折后周围2，3级血管的情况。 目的：利用磁共振三维血管成像技术评估股骨颈骨折股骨头血运状况，为手术方式的选择提供依据。 方法：选择2008-07/12宜春学院临床医学院收治的未行磁共振及三维血管成像检查16例股骨颈骨折患者，行闭合复位两枚双头加压螺钉固定(对照组)。选择2009-01/2011-02收治的行磁共振及三维血管成像检查的股骨颈骨折患者33例，根据检查结果对患侧旋股内侧动脉情况良好的30例行闭合复位两枚双头加压螺钉固定(实验组)，另3例行髋关节置换。 结果与结论：对照组中11例骨性愈合，5例出现股骨颈吸收，需行二次手术；实验组中29例骨性愈合，1例需行二次手术。说明磁共振三维成像技术能够清晰地显示骨颈骨折周围2~3级血管成像，指导手术选择，对预后做出较准确判断，减少二次手术的发生。     

海绵窦区自发性硬脑膜动静脉瘘血管内治疗研究

目的 探讨自发性海绵窦区硬脑膜动静脉瘘（cavernous sinus dural arteriovenous fistula，CSDAVF）的 临床特点及血管内介入栓塞治疗的疗效。 方法 回顾性分析2017年9月-2020年1月于首都医科大学附属北京同仁医院神经外科收治的经DSA 检查确诊为自发性CSDAVF并行介入栓塞治疗的连续住院患者临床资料。采用经静脉入路或动脉入 路进行动静脉瘘栓塞术，根据情况采用单纯Onyx胶或联合弹簧圈进行栓塞，术后即刻及1年复查 DSA，比较经静脉入路和经动脉入路患者的栓塞程度，根据术后1年随访资料比较两组的1年临床预 后情况。 结果 共纳入25例患者，年龄21～72岁。6例（24.0%）患者采用单纯Onyx胶栓塞，19例（76.0%）患者 采用Onyx胶联合弹簧圈治疗。经静脉入路组17例，经动脉入路组8例。术后即刻DSA显示经静脉入路 组12例（70.6%）完全栓塞，4例（23.5%）次全栓塞，1例（5.9%）部分栓塞；经动脉入路组7例（87.5%） 完全栓塞，1例（12.5%）部分栓塞。1年随访DSA显示，经静脉入路组12例（70.6%）完全栓塞，4例 （23.5%）次全栓塞，1例（5.9%）部分栓塞，经动脉入路组5例（62.5%）完全栓塞，2例（25.0%）次全 栓塞，1例（12.5%）部分栓塞，两组术后即刻和1年栓塞率差异无统计学意义。术后1年经静脉入路组 11例（64.7%）临床治愈，5例（29.4%）好转，1例（5.9%）无效；经动脉入路组6例（75.0%）治愈，2例 （25.0%）好转，两组1年临床预后差异也无统计学意义。 结论 对于CSDAVF患者，血管内治疗安全有效，经静脉入路和经动脉入路术后即刻和1年的栓塞率、 1年临床预后相似。     

椎动脉颅内段急性闭塞伴与不伴基底动脉栓塞的对比研究

目的对比分析动脉粥样硬化性椎动脉颅内段急性闭塞(ICAD-AIVAO)伴与不伴基底动脉栓塞患者的临床特点及治疗效果。方法前瞻性纳入2017年2月至2021年6月就诊于河南省人民医院脑血管病科并于发病24 h内接受急诊血管内治疗的ICAD-AIVAO患者, 收集患者的临床、影像学、治疗及随访资料。所有患者的AIVAO均由动脉粥样硬化原位血栓形成(ISAT)所致, 根据是否伴有动脉到动脉栓塞累及基底动脉, 将患者分为ISAT组和ISAT+基底动脉栓塞组。比较两组患者的基线资料、治疗情况及预后。结果共纳入52例患者, 男性占90.4%(47/52), 进展型起病占57.7%(30/52)。与ISAT组(32例)比较, ISAT+基底动脉栓塞组(20例)术前基于弥散加权成像(DWI)的后循环Alberta卒中项目早期CT评分(DWI-pc-ASPECTS)和基底动脉CT血管成像(BATMAN)评分低, 脑桥中脑指数高, 中脑梗死、脑干梗死者的占比均更高(均P<0.05)。ISAT+基底动脉栓塞组机械取栓次数较ISAT组多[M(Q1, Q3)分别为2(1, 2)次、1(0, 2)次, P=...     

脊柱手术出血中间充质干细胞的分离鉴定及数量变化*★

背景：胰肾联合移植已经被公认为是糖尿病(包括1型和2型)合并终末期尿毒症的有效治疗手段，由于胰腺为高免疫原性器官，合理的免疫抑制治疗是保证胰腺移植成功的关键。 目的： 探讨胰肾一期联合移植后免疫抑制药物的合理应用。 方法：纳入2005-01/2009-06在中山大学附属第一医院器官移植中心完成胰肾一期联合移植的患者9例，其中男5例，女4例，胰液引流均采用空肠引流方式。术后采用白细胞介素2单克隆抗体诱导的四联免疫抑制方案：白细胞介素2单克隆抗体+他克莫司+麦考酚酸+激素，并逐渐过渡至单用他克莫司维持治疗。回顾性分析以上9例患者围手术期及长期随访情况。 结果与结论：胰肾一期联合移植后，除1例早期死亡外，其余8例患者移植后1周内肌酐降至正常水平，移植后停用胰岛素时间为(11.5±3.5) d，空腹血糖恢复至正常时间为(15.4±6.3) d。8例患者随访4~50个月期间，共有4例发生移植肾急性排斥，其中1例在接受床边血液透析过程中并发心脑血管意外后家属放弃治疗，其余3例患者经抗胸腺细胞球蛋白或激素冲击治疗后移植肾功能均逆转恢复，随访过程中未发现移植胰腺排斥。说明胰肾联合移植是治疗糖尿病合并终末期糖尿病肾病的有效方法，术后早期采用白细胞介素2单克隆抗体诱导的四联免疫抑制方案并逐渐过渡至单用他克莫司维持治疗是安全的。     

椎动脉夹层动脉瘤的影像诊断与血管内治疗

目的总结椎动脉夹层动脉瘤的影像学诊断和血管内治疗经验。方法回顾性分析18例椎动脉夹层动脉瘤的磁共振成像和血管造影影像学特点和血管内治疗经过。结果影像特点为MR内膜瓣与壁间血肿,DSA珠线征,双腔征等。12例支架治疗中4例单纯支架后造影复查不显影,8例支架联合弹簧圈栓塞7例造影复查不显影;6例载瘤动脉闭塞4例造影复查不显影,全部病人临床随访症状消失。15例DSA复查随访,夹层动脉瘤不显影,无复发。结论DSA及MR检查对椎动脉夹层动脉瘤具有诊断价值;血管内治疗如支架技术（单纯置入或联合弹簧圈栓塞）以及载瘤动脉闭塞是椎动脉夹层动脉瘤安全、有效的选择。     

急性血栓性和栓塞性大脑中动脉M1段闭塞的临床研究

目的研究急性血栓性和心源性栓塞性大脑中动脉闭塞(MCAO)的临床特点的差异。方法选择5年内急诊住院的被磁共振血管成像(MRA)证实为急性大脑中动脉M1段急性闭塞的患者67例,其中血栓组45例,栓塞组22例,在未接受溶栓治疗的情况下,比较分析两种病因导致的MCAO患者危险因素,入院时及发病后14 d NIHSS评分,出血性转化发生率。结果血栓性MCAO患者年龄小于栓塞性MCAO患者;入院当日血栓形成患者NIHSS评分(6.42±3.38)显著小于栓塞性患者(11.67±8.50),P<0.01,14 d时这种差别仍然存在;栓塞组出血性转化率显著高于血栓形成组。结论栓塞性MCAO患者发病年龄大,临床症状重,预后不良,强烈建议开展超早期的动脉溶栓。     

急性大脑中动脉栓塞的局部动脉内溶栓治疗（附7例报告）

目的:评价局部动脉内溶栓和经皮腔内血管成形术(PTA)结合在治疗急性大脑中动脉栓塞中的应用。方法:7例急性大脑中动脉栓塞用局部动脉内灌注组织纤溶酶原激活物(t-PA)溶栓,6例M_1段同时存在狭窄,用PTA成功消除;所有病例均在发病6h内开始治疗。结果:7例栓塞动脉均获得完全再通,6例M_1段狭窄用FTA消除,5例偏瘫完全恢复,1例有脑出血并发症。结论:局部动脉内溶栓和PTA结合可能是治疗急性大脑中动脉栓塞的有效方法。     

颅内外高流量搭桥术治疗巨大海绵窦动脉瘤

目的 探讨高流量搭桥术治疗巨大海绵窦动脉瘤的可能性及治疗经验和教训.方法 通过游离、移植小腿部大隐静脉;暴露颈部颈总动脉、颈内外动脉颅外段和翼点入路开颅手术,显露颈内动脉床突上段(1例)或大脑中动脉M1,M2段(4例),然后进行颅内外血管吻合术.结果 4例术后7-14 d行脑DSA和(或)CTA复查证实搭桥血管通畅良好.4例患者术后头痛症状均消失,3例复视患者中2例症状消失,1例无缓解;2例视力下降者均改善;术后1例搭桥的大隐静脉因急性血栓形成而发生脑梗死昏迷,术后10 d死于肺部感染.结论 采用颅内外高流量搭桥术治疗是治疗某些巨大海绵窦动脉瘤的有效方法,但这种高流量动脉搭桥术仍有一定的风险性,应进行术前脑血流动力学评价,严格控制手术适应证.     

Internal carotid artery dissection among younger and older patients with acute ischemic stroke

Purpose/Aim of the study: Carotid artery dissection (CAD) is a known causative factor in the etiology of acute ischemic stroke in young patients. However, the significance of CAD in older patients with acute ischemic stroke is unclear with only a few prior clinical studies. In order to isolate the influence of CAD as an independent factor, we performed multivariate analyses of common covariables in acute ischemic stroke patients in northern Israel.

Materials and Methods: Three hundred and forty-seven consecutive patients who suffered from acute ischemic stroke had initial CT angiography (CTA) ordered from the emergency room. We reviewed the CTAs for radiologic signs of CAD, and recorded patients’ demographic and clinical data from the hospital's computerized information system.

Results: Eighteen of the 347 patients (5.19%) had CTA evidence of CAD, with no statistically significant differences based on age, gender or ethnicity. A statistically significant inverse association between hypertension and a lower rate of CAD was found before and after stepwise logistic regression, while hyperlipidemia showed a trend toward a similar inverse association that was borderline for statistical significance.

Conclusions: Our study shows that CAD is an independent and significant causative factor for acute ischemic stroke. Therefore, diagnostic imaging is indicated to rule out CAD not only in young patients, but rather in all patients with acute ischemic stroke. The inverse correlation between common vascular risk factors (i.e. hypertension and hyperlipidemia) and CAD points to CAD as an independent nonatherosclerotic causative factor in the etiology of acute ischemic stroke.     

The CD40/CD40L system regulates rat cerebral microvasculature after focal ischemia/reperfusion via the mTOR/S6K signaling pathway

Objective: The role of CD40/CD40 ligand (CD40L) in microvascular thrombosis is now widely accepted. However, the exact mechanisms linking the CD40/CD40L system and the soluble form of CD40L (sCD40L) with microvascular thrombosis are currently a topic of intensive research. The objective of this study was to assess the potential mechanisms in CD40/CD40L system-regulated microvascular thrombosis after focal ischemia/reperfusion (I/R).

Methods: Rats were subjected to 60-min transient middle cerebral artery occlusion (MCAO). The experiments were divided into three groups: sham operation, MCAO, and MCAO + CD40 antagonist. Dynamic changes of serum-free sCD40L levels for 0, 1, 3, 5, 6, and 12 h by ELISA detecting kit after focal I/R were observed, and the CD40 expression levels in both platelet surface and vascular endothelial cell surface were measured by flow cytometry and immunofluorescence, respectively. Cerebral infarct volume was analyzed 12 h after reperfusion. mTOR/S6K signaling was determined by Western blot.

Results: A comparison of thrombus formation between MCAO and CD40 antagonist treatment rats revealed a role for CD40 and/or CD40L in the inflammation-enhanced thrombosis responses in both of the platelet and vascular endothelial cell. MCAO rats yielded an acceleration of thrombus formation that was accompanied by increased CD40 levels in serum. The brain infarction was significantly decreased in CD40 antagonist treatment group compared to MCAO model group. The mTOR/S6K signaling was activated in MACO model than that of CD40 antagonist treatment group.

Conclusions: Our findings indicate that CD40/CD40L system contributes to microvascular thrombosis and brain infarction induced by MCAO and reperfusion. The mTOR/S6K signaling pathway is involved in the regulation of cerebral microvasculature after focal I/R by CD40/CD40L.

Abbreviations:

AKT: protein kinase B; CD40L: CD40 ligand; CSF: cerebrospinal fluid; FITC: fluorescein isothiocyanate; I/R: ischemia/reperfusion; MCAO: middle cerebral artery occlusion; mTOR: mechanistic target of rapamycin; PE: P-phycoerythrin; sCD40L: soluble form of CD40L; TNF-a: tumor necrosis factor-alpha; WT: wild type.     

Persistent trigeminal artery feeding a hemispheric branch of the posterior inferior cerebellar artery: a rare anatomic variant

Persistent trigeminal artery is a rare persistent carotid-basilar anastomosis that usually connect the infracavernous segment of the ICA with the basilar artery. Rarely, PTA may feed cerebellar artery. We describe an exceptional case of PTA terminating in postero-inferior cerebellar artery (PICA) hemispheric branch. Angiographic and CTA features are presented and hypotheses regarding developmental origin of this variation are discussed.     

Occurrence of spot signs from hypodensity areas on precontrast CT in intracerebral hemorrhage

Objective: Both the spot signs, which is a bright spot on computed tomography angiography (CTA) source images, and hypodensity areas within a hematoma on precontrast CT scans, which presumably represent uncoagulated blood, have been reported to be predictive of hematoma enlargement in acute spontaneous intracerebral hematoma (ICH). The aim was to investigate densities on precontrast CT scans in an area within a hematoma that matched the locations of spot signs on CTA source images.

Methods: In consecutive cases of spontaneous ICH admitted within 6 h after onset, early spot signs on CTA source images and delayed spot signs on delayed-phase CT scans 90 s after CTA were evaluated.

Results: Of 177 patients undergoing CTA, 41 (23.2%) showed early spot signs. Among 146 patients who underwent delayed-phase CT scans, 23 (15.8%) demonstrated delayed spot signs but not early spot signs. Spot signs originated from hypodensity areas, including densities <50 HU, in 30 of 35 patients (85.7%) with early spot signs and in 8 of 23 (34.8%) with delayed spot signs. Early spot signs arose from hypodensity areas more frequently than delayed spot signs (p < 0.05). Hematoma enlargement was observed in 10 of 24 patients (41.7%) with early spot signs, but in none with delayed spot signs.

Discussion: Some hypodensity areas within ICHs may indicate uncoagulated blood related to ongoing leakage, which are seen as spot signs. Minimum densities in hypodensity areas might correlate with the speed and volume of bleeding.     

Recanalization of Completely Thrombosed Non-Giant Saccular Aneurysm Mimicking as De Novo Aneurysm

Partial thrombosis of giant aneurysms is not uncommon however, complete angiographic occlusion occurs less frequently. In the case of non-giant aneurysms, complete thrombosis and recanalization has been rarely reported. A 31-year-old man presented to the emergency department with sudden bursting headache. Brain computed tomography (CT) revealed diffuse subarachnoid hemorrhage on the left side. Both CT angiography (CTA) and digital subtraction angiography showed suspicion of small left anterior choroidal artery aneurysm. We performed surgical exploration. In the operation field, anterior choroidal artery aneurysm of 2 × 2 mm with broad neck and friable appearance was observed. Because we could not clip without sacrificing the anterior choroidal artery, we performed wrapping only. Follow up CTA after 7 months demonstrated 4 mm right internal carotid artery bifurcation aneurysm. The patient underwent aneurismal neck clipping. During the operation, 9 × 13 mm sized thrombosed aneurysm was detected and completely clipped. We initially thought this aneurysm to be a de novo aneurysm however, it was an aneurysm that had recanalized from a completely thrombosed aneurysm. This case report provides an insight into the potential for complete thrombosis and recanalization of non-giant aneurysms.     

A therapy against vasospasm after subarachnoidal haemorrhage: clinical experience of balloon angioplasty

Vasospasm is a phenomenon often present in human cases after subarachnoidal haemorrhage. Its aetiology and pathophysiology are unknown. As a result, cases of vasospasm do not respond to any known pharmacological therapy. We present in this paper, a practical application of intravascular surgery for vasospasm. In this procedure the requirement for a portable digital subtraction unit, transcranial Doppler sonography, and being able to determine quickly the neurological state of the patient are very important points. The use of monitoring equipment is especially indispensable during the carrying out of percutaneous transluminal angioplasty (PTA), which should be performed as soon as possible after the occurrence of vasospasm. The case of a 54-year-old male patient suffering from a ruptured anterior cerebral artery aneurysm was studied. Neck clipping was performed on the second day. On the fifth day the neurological state was stupor, and transcranial Doppler sonography (TCD) revealed a flow velocity of over 100 cm s-1. PTA was performed on the sixth day. The bilateral middle cerebral artery was dilated and the flow velocity slowed to within the normal range. The neurological state improved to clouding of consciousness after PTA. On the eighteenth day, the patient's consciousness and bilateral carotid angiograms revealed the vessels to be dilated still. It was concluded that PTA therapy, and the use of a portable digital subtraction unit and TCD sonography, for vasospasm caused by subarachnoidal haemorrhage is useful and effective.     

Haemostatic function in patients undergoing coronary artery bypass grafting: peroperative perturbations and relations to saphenous vein graft closure

Vein graft failure remains a major problem after coronary artery bypass grafting. Occlusion in the first weeks usually is caused by thrombosis, whereas intimal hyperplasia and eventually atherosclerotic changes with superimposed thrombus formation underlie subsequent closure. The present investigation was conducted as a pilot study to examine whether perturbations of haemostatic function predispose to early saphenous vein graft occlusion after coronary artery bypass grafting. Pre- and postoperative determinations (performed on the first, third, and sixth postoperative days) of haemostatic factors and inhibitors were related to the presence of graft occlusion assessed by angiography at 3 months after surgery in 100 men undergoing elective coronary artery bypass grafting for stable angina pectoris. Occlusion of one or more vein grafts within three months of surgery occurred in 23 of the 100 patients examined. The percentage increase in plasma plasminogen activator inhibitor-1 activity on the first postoperative day was significantly higher in patients who subsequently were found to have vein graft occlusion (p<0.05). Otherwise no postoperative haemostatic measurements were found to predict early vein graft closure. A perturbed plasma plasminogen activator inhibitor-1 response to coronary artery bypass grafting tentatively could be added to the vessel-specific factors that remain the main determinants of early vein graft closure.     

Transluminal angioplasty for arteriosclerotic disease of the distal vertebral and basilar arteries.

OBJECTIVE: Percutaneous transluminal angioplasty (PTA) for the distal vertebral and basilar artery is now being performed in selected patients with haemodynamically significant lesions of the posterior cerebral circulation. Its effect and overall results were examined. PATIENTS AND METHODS: A balloon dilatation catheter specifically developed for these procedures, with a 2.0-3.5 mm balloon diameter, at 6 atmospheres of pressure, was used. Angioplasty was performed in 12 patients (including six whose initial results have been reported) with angiographically documented stenotic lesions involving either the intracranial vertebral artery (C1-C2 portion) or the basilar artery, and satisfying the following criteria: (1) clinical symptoms suggestive or consistent with a transient ischaemic attack refractory to medical treatment, or small infarction of the posterior circulation; and (2) angiographically documented stenosis greater than 70%. Two of 12 patients had complete thrombosis of the distal vertebral and basilar artery and PTA was performed after successful intra-arterial thrombolysis. RESULTS: Successful results, without complications, were obtained in eight patients, with complete resolution of vertebrobasilar ischaemic symptoms. Immediate complications occurred in four patients including two with vessel dissection, and two with thromboembolism. The two patients with acute arterial dissection were reoperated but developed small infarctions with permanent neurological deficits. The two patients with thromboembolic complication showed transient neurological deficit. The overall stenosis ratio decreased from a mean of 84% pretreatment to 44% after the angioplasty procedure. Restenosis occurred in two patients. Long term clinical follow up in 11 patients who survived more than six months showed resolution of ischaemic symptoms after PTA in all except for one with a restenosis who had recurrent transient ischaemic attacks. CONCLUSION: Transluminal angioplasty may be an effective procedure to treat vertebrobasilar ischaemia secondary to high grade arteriosclerotic disease affecting either the distal vertebral or basilar artery regions that do not respond to medical treatment.