血管内治疗椎动脉夹层动脉瘤18例

目的 探讨椎动脉夹层动脉瘤的发病机制，评价血管内治疗椎动脉夹层动脉瘤的技术方法及临床疗效。方法 应用血管内治疗技术对18例椎动脉夹层动脉瘤的患者进行诊断、治疗，回顾性分析临床资料、血竹内治疗经过以及临床疗效。结果 18例患者中有6例直接闭塞动脉瘤和载瘤动脉，7例行支架辅助弹簧圈栓塞，4例行双支架置入术，1例单纯闭塞载瘤动脉。术后12例患者接受随访．随访时间为3个月至2年，平均8个月。随访期间曾经有过蛛网膜下腔出血的7例患者临床症状减轻或消失，没有再出血，2例术后临床症状未见改善。18例患者中3例死亡。结论 血管内治疗椎动脉夹层动脉瘤最有效的方法，是将载瘤动脉连同动脉瘤完全闭塞，如果动脉瘤位于优势椎动脉，或对侧椎动脉发育不良甚至闭塞，或动脉瘤瘤体发出优势小脑后下动脉，应该使用支架血管成形辅助弹簧圈填塞动脉瘤或双支架置入技术。     

椎动脉动脉瘤的血管内治疗

目的评价不同形态椎动脉动脉瘤血管内治疗方法的选择及临床疗效。方法回顾性分析42例患者47个动脉瘤的临床资料,其中单纯微弹簧圈栓塞3例、支架结合微弹簧圈栓塞10例、动脉瘤及近端载瘤动脉闭塞23例、单纯支架植入5例、未治疗1例。结果术后即刻造影动脉瘤完全栓塞16个,近全栓塞8个,部分栓塞20个。结论椎动脉动脉瘤的血管内治疗是安全的、有效的,载瘤动脉闭塞术及支架结合弹簧圈技术对椎动脉梭形、夹层及宽颈巨大囊状动脉瘤是有效的。     

颅内椎动脉夹层动脉瘤血管内治疗策略及效果分析

目的 初步分析颅内椎动脉夹层动脉瘤血管内治疗的安全性及临床效果.方法 回顾性连续纳入2016年1月至2019年12月在苏州大学附属第一医院神经外科接受血管内治疗[载瘤动脉闭塞术和保留载瘤动脉通畅的重建性手术(单纯支架置入术、支架辅助弹簧圈栓塞术)]的颅内椎动脉夹层动脉瘤患者41例.收集患者的一般资料以及临床资料,一般资...     

血管内治疗出血性椎动脉不同部位夹层动脉瘤的疗效分析

目的：探讨血管内治疗出血性椎动脉不同部位夹层动脉瘤的有效性及安全性。方法根据出血性椎动脉夹层动脉瘤的不同部位,3例出血性椎动脉夹层动脉瘤患者使用单纯弹簧圈闭塞椎动脉,2例行双支架置入,16例行支架辅助微弹簧圈栓塞。结果 CT血管成像及磁共振血管造影随访7例,数字减影血管造影随访14例,随访时间3～24个月、平均12．4个月。患者临床症状均不同程度改善,未发生再次出血。3例使用单纯弹簧圈闭塞椎动脉的患者未见动脉瘤显影,患侧椎动脉闭塞,对侧椎动脉显影良好,颅内血管代偿良好;2例行双支架置入者行数字减影血管造影复查示夹层较术前明显缩小;行支架辅助微弹簧圈栓塞的16例患者中,11例致密填塞者夹层未见显影,另5例行支架辅助微弹簧圈大部填塞患者中,3例夹层无改变、2例瘤体缩小。结论对出血性椎动脉不同部位夹层动脉瘤患者选择恰当的血管内治疗方法,疗效好而安全。     

颅内外血管搭桥加动脉瘤孤立术治疗椎动脉-小脑后下动脉梭形动脉瘤三例

梭形动脉瘤约占颅内动脉瘤的1%，而椎动脉-小脑后下动脉（VA-PIGA）梭形动脉瘤更为罕见，并且PICA常开口于动脉瘤上，进行开颅直接手术塑形夹闭或经血管内栓塞治疗都十分困难。2005年2月至6月，作者采取颅内外血管搭桥加动脉瘤孤立术治疗首都医科大学宣武医院神经外科3例VA-PICA梭形动脉瘤患者，现将经验报道如下。     

双侧椎动脉入路闭塞椎动脉夹层破裂动脉瘤的疗效分析

目的探讨经双侧椎动脉入路血管内治疗颅内椎动脉夹层破裂动脉瘤的效果。方法回顾性分析5例颅内椎动脉夹层破裂动脉瘤患者的症状和影像检查结果。对5例均采取经双侧椎动脉入路,使用弹簧圈栓塞夹层动脉瘤,将夹层动脉瘤两端致密填塞,中段疏松填塞,将动脉瘤隔离于血循环之外。结果 5例接受治疗的患者中,4例临床症状迅速好转,无肢体活动及精神异常。治疗后6个月随访改良Rankin评分(mRS)4例0分,1例4周后意识转清,6个月时随访mRS3分。治疗前DSA显示为椎动脉扩张和狭窄,椎动脉平均受累长度为(9.3±1.5)mm;治疗后5例夹层动脉瘤均完全不显影,无再出血发生,未见有新发梗死。6个月后随访未见动脉瘤复发及载瘤动脉再通。结论采取双侧椎动脉入路闭塞椎动脉夹层破裂动脉瘤,技术上是可行的,可能是一种有效防止再出血的治疗方法。     

椎动脉夹层动脉瘤的诊疗现状

椎动脉夹层动脉瘤是一种常见的颅内血管疾病。根据夹层动脉瘤病变性质和部位的不同，在临床上主要表现为缺血性卒中或蛛网膜下腔出血（SAH），而以SAH为首发症状的患者，其发生动脉瘤再次破裂出血的可能性远大于相同部位的囊状动脉瘤患者。因此，在临床上，椎动脉夹层动脉瘤一旦明确诊断，均应尽快采取积极有效的治疗，降低病死率或致残率。     

椎动脉栓塞术在老年颈椎肿瘤切除术中减少失血的应用价值

椎动脉损伤的处理是颈椎肿瘤手术中的一个重要环节,临床上常采用术中结扎的方法。由于椎动脉第2段(椎骨段)在解剖学上的特殊性,结扎时可能导致血管破裂出血。如上述出血发生于老年患者,则极易出现严重并发症甚至导致死亡。本     

老年椎动脉V4段及基底动脉夹层动脉瘤行血管内治疗的疗效分析

目的 探讨老年椎动脉V4段及基底动脉夹层动脉瘤引起蛛网膜下腔出血患者使用不同支架辅助弹簧圈栓塞治疗的有效性与安全性。方法 选择2016年1月～2020年12月北部战区总医院神经外科收治的自发性蛛网膜下腔出血椎动脉V4段及基底动脉动脉瘤并顺利完成手术患者54例,将35～60岁的20例作为中青年组,年龄>60岁的34例作为老年组。回顾性分析患者术中和术后并发症情况及动脉瘤复发情况。结果 术中和术后出现并发症10例(18.5%),其中术中6例;术后远期责任血管缺血4例。随访期间,动脉瘤复发12例(22.2%),其中单支架辅助弹簧圈栓塞复发7例,多支架辅助弹簧圈栓塞复发3例,半密网支架辅助弹簧圈栓塞动脉瘤复发2例,密网支架患者复发0例。复发时间在6～10个月5例、11～14个月5例、15～18个月2例。老年组与中青年组并发症发生率和动脉瘤复发率比较,均无统计学差异(20.6%vs 15.0%,17.6%vs 30.0%,P>0.05)。结论 椎动脉及基底动脉夹层动脉瘤患者可行血管内治疗,应根据患者血管硬化程度、血管结构、动脉瘤位置选择适合手术方式。     

经颅多普勒超声在椎动脉狭窄血管成形术的应用

目的 应用经颅多普勒超声(TCD)检测症状性椎动脉起始段狭窄支架成形术前和术后的血流动力学改变,探讨TCD在术前评估、术后随诊中的应用.方法 回顾性分析接受支架成形术的椎动脉起始段狭窄病例6例,所有病例治疗前后均行TCD检查,平均随访6月.结果 术前TCD改变:①6例狭窄侧椎动脉起始段流速显著增快,频谱异常.②4例双侧椎动脉寰枢段及颅内段不对称,狭窄侧血流速度减慢,伴或不伴搏动指数(PI)减低.其中2例狭窄侧椎动脉寰枢段血流速度减慢,而椎动脉颅内段流速正常.③4例术前对侧椎动脉流速高于正常, 2例基底动脉血流高于正常.术后TCD改变:①狭窄段血流速明显下降,狭窄远端流速增高,均接近正常流速,狭窄远端的PI明显改善.②术前存在健侧椎动脉流速增快的4例患者,在术后出现了不同程度的流速下降,对于基底动脉流速增快病例,术后BA流速亦出现下降.结论 TCD是椎动脉起始段狭窄术前评估及介入治疗后观察血流动力学改变的有效手段,能准确地评价治疗效果并可用于长期随访.     

Unusual vertebral artery origins: examples and related pathology.

Anomalies of the vertebral arteries are uncommon, but important to recognize in the diagnosis and catheter based evaluation and treatment of patients suffering cerebrovascular disease. This article illustrates our experience with such anomalies. These include the vertebral artery arising as the fourth and most distal branch of the aortic arch, as a right subclavian artery branch arising distal to the right thyrocervical trunk, as a right common carotid artery branch in a patient with an aberrant right subclavian artery, and a case of left vertebral artery proximal duplication, with both aortic and left subclavian vertebral arteries present in the same patient; the latter join to form a single distal cervical vertebral artery.     

Complex right subclavian artery dissection during diagnostic cardiac catheterization

Vascular complications are important and unfortunate sequelae of cardiac catheterization. We report a case of complex right subclavian artery dissection following attempted diagnostic cardiac catheterization of a right internal mammary artery (RIMA) coronary bypass graft. Subsequent dissection of the right subclavian artery involved the origin of the right vertebral and internal mammary arteries, as well as producing critical right upper limb ischemia. The anatomy dictated that therapy consist of conservative management of the proximal dissection involving the vertebral artery and the RIMA graft origins, with endovascular stent deployment at the distal site of the vessel occlusion. This example reinforces the need for prompt diagnosis and management of vascular complications, and emphasizes the need for available, appropriate skills relevant to the peripheral vascular interventions.     

Extracranial vertebral artery intervention

Atherosclerosis is the commonest cause of vertebral artery stenosis and has a predilection for the origin and proximal section of the extracranial portion of the vessel and also the intracranial portion of the vessel. Although it has generally been thought that extracranial vertebral artery (ECVA) disease has a more benign outcome compared to intracranial vertebral artery disease, significant occlusive disease of the proximal vertebral artery is the primary cause of vertebral artery ischemia in a significant proportion of patients. We focus on the interventional management of patients with proximal ECVA disease in this article.     

A "Triple-Steal Syndrome" Resulting from Innominate and Left Subclavian Arterial Occlusion

Summary: A case of extracranial arterial occlusive disease involving the origin of both subclavian arteries and the proximal right common carotid artery is presented. The left common carotid artery was the only vessel of supply to the entire brain and both upper limbs, a "steal" phenomenon occurring retrogradely down both vertebral arteries and the right internal carotid artery to fill the distal subclavian arteries and the right external carotid artery respectively. Surgery was undertaken to establish continuity of flow in all occluded vessels with good results.     

Percutaneous revascularization of the “unprotected” left main during acute myocardial infarction: “Dare to struggle! Dare to Win!”

Knowing the location of the vertebral and the internal mammary artery ostia is crucial during proximal subclavian artery percutaneous intervention to prevent inadvertent injury to either artery. We report a case of severe proximal left subclavian artery stenosis in a patient with a three‐vessel disease referred to coronary artery bypass graft surgery. Retrograde angiography via left radial access allowed visualization of the left internal mammary artery and the left vertebral artery ostia and placement of a Filterwire in the left vertebral artery. The proximal left subclavian artery was successfully stented without complications. Debris was retrieved in the Filterwire. © 2009 Wiley‐Liss, Inc.     

Disease of proximal part of vertebral artery in patients with coronary artery disease

Recognition of coincidence of cerebral vascular disease is of importance in patients with coronary artery disease. One hundred and seventy-three patients who underwent coronary angiography were also studied by angiography of subclavian arteries and abdominal aorta. The majority of the patients (128/173; 74%) were men. Risk factors of hypertension, diabetes, and hypercholesterolemia were present in a high percentage of patients. Disease of the proximal part of the vertebral artery was seen in 41.6% (72/173). Presence of vertebral artery disease was significantly correlated with diabetes (p = 0.02), renal artery stenosis (p = 0.003), coronary artery disease (p = 0.05), and iliac artery disease (p = 0.05). The proximal part of the vertebral artery was found to be affected in a high percentage (41.6%) of patients undergoing coronary angiography.     

Epidemiology of osteoporotic fractures

Patients with vertebral, hip, distal radius, and proximal humerus fractures are most common among the osteoporosis-related fractures. The incidences of these fractures increase with age, however, the increase patterns differ between the fracture sites. The prevalence of vertebral fracture for Japanese is similar or slightly higher and the incidences of osteoporosis-related limb fractures are lower than those for Caucacians. A decrease in prevalence of vertebral fractures and an increase in the incidence of limb fractures are the secular trend in Japan. Previous fractures are significant risk factor for both vertebral and hip fractures. Greater physical activity increases the risk of distal radius fractures, and decreases the risk of proximal humerus fractures.     

Indications for revascularization of the distal cervical vertebral artery

Since the development of the technique of revascularizing the vertebral artery in its transversal and suboccipital portions, 22 revascularisation procedures of the distal vertebral artery (above C2) have been carried out in 21 patients. The earliest cases have been followed up for more than 4 years and the technique has proved to be reliable, both from the clinical and anatomical points of view. The indications were based on restoration of the vertebral axis compromised by major lesions (stenosis: 2 cases, occlusion: 14 cases) of both vertebral arteries (13 cases) or of the dominant vertebral artery in symptomatic patients (3 cases). Surgery was also offered to preserve a vascular axis which had to be sacrificed for the treatment of potentially embolic disease (aneurysm or dissection: 3 cases) or hypervascular lesions (arteriovenous malformation, tumour: 2 cases). However, the indications for distal cervical vertebral artery revascularization should be carefully considered as it is impossible to evaluate the long-term tolerance of major vertebral arterial lesions.     

Changes in the diameter of the coronary arteries in heart transplant recipients with angiographically normal vessels during five years]

INTRODUCTION: Diffuse or focal coronary artery narrowing is a frequent complication of cardiac transplantation. Coronary enlargement has also been described although it is less known. To study the changes of the coronary arteries in transplant recipients, we have performed a quantitative study throughout 5 years. METHODS: Serial coronary angiography was performed annually in all survivors of heart transplant. Forty four patients with visually normal coronary arteries and at least 5 years of evolution were selected for this study. Quantitative measurements of the diameter of the coronary arteries were performed in each angiogram at different levels: proximal, medium and distal left anterior descending coronary artery; proximal and distal left circumflex; proximal, medium and distal right coronary artery. Changes in diameter were compared throughout the 5 years. RESULTS: In the entire group of patients there was a small increase in the diameter of each segment. Taking each patient separately, an enlargement of the diameter of the proximal descending coronary artery was seen in 17 cases; medium descending coronary artery in 13; distal descending coronary artery in 8; proximal left circumflex in 11; distal left circumflex in 14; proximal right coronary artery in 18; medium right coronary artery in 18 and distal right coronary artery in 15. In total, 114 of 352 coronary segments (32%) underwent dilatation. Only 6 patients failed to have dilatation of any segment. CONCLUSIONS: Enlargement of the coronary arterial diameter was seen in 32% of segments of the main coronary arteries in heart transplant recipients with angiographically normal coronary arteries during 5 years of evolution. This could be due to intimal thickening with overcompensation by an additional vessel enlargement with net lumen gain.