Vertebrobasilar transcranial color-coded duplex ultrasonography: improvement with echo enhancement

BACKGROUND AND PURPOSE: The diagnostic yield of vertebrobasilar transcranial color-coded duplex ultrasonography (US) is often hampered by insufficient acoustic penetration, anatomic variations, and vessel tortousity. The purpose of this study was to evaluate the effect of echo enhancement on vertebrobasilar transcranial color-coded duplex US. METHODS: In 23 consecutive patients (mean age, 61.0 +/- 11.1 years) with vertebrobasilar stroke, the vertebrobasilar system (P1 segment of the posterior cerebral artery [PCA], basilar head, V4 segment of the vertebral artery, and basilar artery) was examined with transcranial color-coded duplex US before and after injection of an echo-enhancer. The acoustic window was graded according to visibility of parenchymal structures, and vessel imaging was graded according to the appearance of the color mode signal. Maximum depth of the basilar color signal was recorded. All patients with an abnormal or inconclusive US finding underwent either digital subtraction angiography or MR angiography. RESULTS: In the P1 PCA, V4 vertebral artery, basilar artery, and basilar head, image quality was insufficient in 65%, 82%, 83%, and 38%, respectively, before echo enhancement, and in 15%, 30%, 35%, and 9%, respectively, after echo enhancement. In all graded vessels, the improved image quality with echo enhancement was statistically significant. Compared with the reference examinations in the 15 cases of occlusion or stenosis, definite diagnosis was possible in 60% (nine cases) with nonenhanced transcranial color-coded duplex US and in 93% of (14 cases) after echo enhancement. CONCLUSION: Echo enhancement resulted in improved image quality of the vertebrobasilar system and markedly increased diagnostic confidence.     

Parallel and spiral flow patterns of vertebral artery contributions to the basilar artery.

PURPOSETo demonstrate that the in vivo flow from individual vertebral arteries can be imaged and tracked in the basilar artery by use of saturation planes with three-dimensional time of flight MR angiography.METHODSTwenty volunteers were studied with intracranial three-dimensional time of flight angiography MR. The MR angiography was repeated with saturation of the individual vertebral arteries. Flow voids and signal intensity within the basilar and posterior cerebral arteries were evaluated for flow patterns.RESULTSOf 15 volunteers with a "normal" vertebrobasilar anatomy, 80% demonstrated a pattern of flow within the basilar artery in which the contributing vertebral components remained ipisilateral. This pattern was called "parallel." A "spiral" pattern of rotation of the contributing vertebral components was found in 20% of studies. The inflow to the posterior cerebral arteries could be identified from specific vertebral contributions and was related to the size-dominance of the vertebral artery.CONCLUSIONThere is nonadmixture of vertebral artery flows of variable duration within the basilar artery; at least two patterns of flow can be described within the basilar artery. The method presented is a simple technique for determining vertebral artery flow components with routine software and without secondary data manipulation.     

TCD和CDFI联合检测对椎-基底动脉狭窄的诊断价值

目的将通过经颅多普勒超声（TCD）和彩色多普勒血流显像（CDFI）联合检测诊断的椎-基底动脉狭窄患者的检测资料进行分析,并与数字减影血管造影（DSA）做对比研究,客观评价二者对椎-基底动脉狭窄的诊断价值。方法经TCD、CDFI诊断的椎-基底动脉狭窄患者38例,均进一步行磁共振血管造影（MRA）、DSA检测,对比分析其检测结果。结果与DSA比较,TCD、CDFI对椎动脉的检测敏感性为83%,特异性为91%;TCD对基底动脉狭窄检测的敏感性为75%,特异性为93%。以DSA为标准,TCD对基底动脉近段、中段、远段的检出率分别为100%、50%和33%。以DSA为标准,TCD＋CDFI对椎-基底动脉狭窄的检出率为79%,MRA的检出率为96%,TCD、CDFI、MRA三者联合检出率为98%。结论①TCD、CDFI对椎-基底动脉狭窄的特异性较高,且无创、经济、方便,故可作为首选筛查手段。但因其敏感性不是很高,故当临床出现后循环神经缺失症状,而检测结果阴性时,可结合MRA检查;②TCD、CDFI、MRA三者联合对VBA狭窄有较好的准确性。     

HRMR-VWI在椎-基底动脉病变诊断中的应用价值

目的探讨高分辨磁共振血管壁成像(high-resolution magnetic resonance vessel wall imaging,HRMR-VWI)在椎-基底动脉病变诊断中的应用价值。方法对52例经CTA/MRA/DSA确诊椎-基底动脉管腔病变的患者,行HRMR-VWI T 1-VISTA序列平扫加增强检查,评估病变段血管壁改变及病因探究。结果52例椎-基底动脉管腔病变患者中,发现24例动脉粥样硬化改变,占46.2%,均表现为偏心性管壁增厚,增强扫描管壁轻度或明显强化;9例原发性中枢神经系统血管炎,占17.3%,表现为管壁向心性增厚,明显强化;12例椎基底动脉夹层,占23.1%,可见内膜瓣,双腔征,夹层开口位置;7例动脉瘤,占13.4%,5例发生于椎动脉,2例发生于基底动脉,HRMR-VWI清晰可见瘤壁厚度及强化特点。结论HRMR-VWI能够为椎-基底动脉病变病因探究、治疗方案制定提供重要信息,是椎-基底动脉病变的重要检查方法。     

Combined stent placement and thrombolysis in acute vertebrobasilar ischemic stroke

BACKGROUND AND PURPOSE: Acute vertebrobasilar ischemic stroke is often associated with high morbidity and mortality with limited therapeutic options. Endovascular treatment with thrombolysis has offered some hope for affected patients; however, overall outcomes have been less than satisfactory. In this report, we present the results of our approach in six consecutive cases of acute vertebrobasilar ischemic stroke by combined proximal vessel stent placement and thrombolysis. METHODS: Six consecutive cases were retrospectively reviewed for the clinical outcome of patients presenting to our institution with acute posterior circulation stroke who underwent cerebral revascularization including proximal arterial stent placement by using balloon-expandable coronary stents and intraarterial thrombolysis. All of these patients were initially evaluated by stroke team neurologists and imaged with MR, including diffusion-weighted imaging documenting acute posterior circulation stroke. MR angiography of the circle of Willis was also obtained. Short-term follow-up was conducted to assess National Institutes of Health stroke scores (NIHSS) and modified Rankin scores. RESULTS: In these six cases, a combined approach of proximal arterial stent placement (five cases of vertebral artery origin and one case of carotid and subclavian stent placement plus vertebral artery revascularization) and thrombolysis was performed at variable times after stroke onset (range, 30 hours to 5 days). Four of the six patients had good basilar artery recanalization (Thrombolysis in Myocardial Infarction [TIMI] grade 0-1 before tissue plasminogen activator thrombolysis and TIMI grade 2 after procedure). Four of six patients had excellent immediate recovery and were discharged to an acute rehabilitation unit or their homes with improved neurologic symptoms and functional status. Two patients died: one patient presented with coma at outset with an NIHSS of 38, and the other patient probably had reocclusion of the basilar artery within 24 hours despite initial postprocedural improvement. CONCLUSION: We demonstrate that, in the setting of acute stroke, stent placement in combination with revascularization and thrombolysis is practical and allows quick access to a clot and simultaneously increases perfusion through collaterals during the thrombolytic process. In particular, basilar thrombolysis may be facilitated by proximal vertebral stent placement as concomitant atheromatous vertebrobasilar stenosis is common.     

Bilateral segmental agenesis of the vertebrobasilar junction: developmental and angiographic anatomy

BACKGROUND AND PURPOSE: Bilateral vertebrobasilar junction agenesis is an exceptional anatomic variation. This article explores the angiographic characteristics of this variant and its embryologic mechanisms. MATERIALS AND METHODS: Two observations of bilateral agenesis of the vertebrobasilar junction are reported. A case of atheromatous disease of the vertebrobasilar junction is shown to highlight characteristics distinguishing such a lesion from the reported variant. RESULTS: In the 2 reported cases, the distal segment of both vertebral arteries (VAs) and the proximal portion of the basilar artery (BA) were absent. In addition, distal connections of the BA with the posterior cerebral arteries (PCA) were also lacking. As a consequence, the remaining portion of the BA was isolated from its usual sources of blood supply, which was provided by a persistent carotid-basilar anastomosis. CONCLUSION: The developmental mechanism underlying bilateral agenesis of the vertebrobasilar junction likely involves the anterior radicular artery of C1. This branch of the proatlantal artery normally becomes the adult distal VA and the proximal BA. The lack of cranial connection of the BA with the PCA may be secondary to the proximal vertebrobasilar agenesis and the resulting paucity of antegrade flow within the BA. Alternatively, the absence of both the proximal and distal connections of the BA could be the result of a similar, yet unknown, developmental mechanism. From a clinical standpoint, this vascular anomaly was discovered incidentally in our 2 patients, a finding consistent with the assumed congenital nature of the variant.     

Distal Embolization After Stenting of the Vertebral Artery: Diffusion-Weighted Magnetic Resonance Imaging Findings

Purpose We retrospectively evaluated our experience with stenting of the vertebral artery in an effort to determine the risk of distal embolization associated with the procedure. Methods Between June 2000 and May 2005, 35 patients with 38 stenting procedures for atherosclerotic disease of the vertebral origin in our institution were identified. The average age of the patients was 60.3 years (range 32–76 years). Sixteen of these patients (with 18 stents) had MR imaging of the brain with diffusion-weighted imaging and an apparent diffusion coefficient map within 2 days before and after procedure. Results On seven of the 16 postprocedural diffusion-weighted MR images, a total of 57 new hyperintensities were visible. All these lesions were focal in nature. One patient demonstrated a new diffusion-weighted imaging abnormality in the anterior circulation without MR evidence of posterior circulation ischemia. Six of 16 patients had a total of 25 new lesions in the vertebrobasilar circulation in postprocedural diffusion-weighted MR images. One patient in this group was excluded from the final analysis because the procedure was complicated by basilar rupture during tandem stent deployment in the basilar artery. Hence, new diffusion-weighted imaging abnormalities were noted in the vertebrobasilar territory in 5 of 15 patients after 17 stenting procedures, giving a 29% rate of diffusion-weighted imaging abnormalities per procedure. No patient with bilateral stenting had new diffusion-weighted imaging abnormalities. Conclusion Stenting of stenoses of the vertebral artery origin may be associated with a significant risk of asymptomatic distal embolization. Angiography, placement of the guiding catheter, inflation of the stent balloon, and crossing the lesion with guidewires or balloon catheters may potentially cause distal embolization. Further studies to evaluate measures to increase the safety of vertebral artery stenting, such as the use of distal protection devices or short-term postprocedural anticoagulation, should be considered for patients with clear indications for this procedure.     

颅颈部血管多层螺旋减影CTA与DSA的比较研究

目的 评价减影CTA对检察颅颈部血管性病变的灵敏度和特异度及其临床应用价值.方法 对76例怀疑颅颈部血管疾病患者施行16层螺旋减影CTA检查,在保证增强前后所采集的数据参数一致的前提下用Neuro-DSA软件进行减影,其中30例与DSA作比较观察.减影CTA图像质量分为优良、一般、差;应用非参数统计检验、计算减影CTA显示病变的灵敏度和特异度.结果 以颈内动脉颅段、前后交通动脉、大脑前中后动脉近段、椎基动脉为观察对象,共观察血管段900段.减影CTA图像质量优良571段,为63.4%,一般有301段,为33.4%.但在显示颅颈部不同段血管的图像质量上有差异;减影CTA检出病变的灵敏度为84.4%,特异度为40%,检出动脉瘤的灵敏度和特异度均为100%.结论 16层螺旋减影CTA无创,快捷,简单易行,能提供较高分辨率的血管图像,可作为一种常规的方法应用于颅颈部血管疾病的筛查和诊断.     

Altered vertebrobasilar flow in children: angiographic,MR, and MR angiographic findings.

PURPOSETo characterize the clinical, MR, MR angiographic, and conventional angiographic findings in vertebrobasilar disease in children.METHODSEight children with posterior circulation ischemia and infarction had conventional spin-echo MR and MR angiography of the head and neck. Six patients had conventional angiography.RESULTSSix patients had alteration of vertebral or basilar artery flow void on spin-echo images. MR angiography showed all six cases of angiographically proved vertebrobasilar dissection or occlusion despite overestimating the extent of arterial abnormality in two patients. In two patients the intracranial peripheral branch cutoff shown at angiography was correctly predicted on screening MR angiography.CONCLUSIONPosterior circulation infarction in children is usually secondary to traumatic injury to the vertebrobasilar circulation. MR and MR angiography noninvasively show vertebrobasilar flow disturbances and compare favorably with angiography in documenting dissection or occlusion of the vertebrobasilar circulation. MR angiography may obviate the need for invasive angiography in these children at diagnosis and during follow-up of anticoagulation therapy.     

多层螺旋CT血管成像对椎基底动脉供血不足病因诊断的应用

目的探讨多层螺旋CT血管成像（MSCTA）对椎基底动脉供血不足（VBI）病因诊断的价值。资料与方法对12例无症状者及42例临床拟诊VBI患者行椎动脉MSCTA检查,原始数据于图形工作站行三维图像处理。结果12例无症状患者中椎动脉发育异常1例,迂曲1例,其他椎动脉及基底动脉无异常。42例拟诊VBI患者,先天发育变异13例,迂曲5例,盘绕3例,钩椎关节增生压迫（Ⅱ＋Ⅲ度）20例,椎体横行移位致血管变形1例,粥样硬化斑块20例,局限性狭窄2例。结论MSCTA可清晰显示椎基底动脉全程及其与颈椎的解剖关系,直观显示发育变异,对椎动脉流人孔的显示具有明显优势,可作为VBI的常规影像检查方法。     

Platinum coil treatment of complex aneurysms of the vertebrobasilar circulation

Summary Two patients with complex aneurysms of the vertebrobasilar system were treated using platinum coils. During these sessions, 22 coils were placed in a basilar tip aneurysm in a 48-year-old woman. Almost total occlusion of the lumen was achieved, excepted in the area from which the right posterior cerebral artery arose. A large fusiform vertebral artery aneurysm in a 6-year-old boy was treated using 16 coils, which partially occluded the lumen at initial embolization. Follow-up angiography 2 weeks later revealed almost complete occlusion of the lumen with preservation of the vertebral artery. Our experience indicates that coil embolization of complex intracranial aneurysms is an acceptable treatment alternative to surgery or to a detachable balloon.     

经颅多普勒超声对锁骨下动脉盗血综合征的诊疗价值

目的通过分析锁骨下动脉盗血综合征（SSS）的经颅多普勒超声（TCD）检测结果及介入治疗前后的椎-基底动脉系统血流动力学改变,评价TCD在SSS中的应用价值。方法回顾性总结经TCD诊断的94例锁骨下动脉盗血综合征患者,均经彩色多普勒血流显像（CDFI）验证,且11例进一步经DSA检查证实。对15例患者分别于6～18个月内进行TCD随访。结果①94例患者中有症状者65例（表现为椎基底动脉供血不足58例,同侧患肢缺血症状6例,胸前区疼痛1例）,无症状者29例;②Ip-VAⅠ度盗血占45%,Ⅱ度盗血占35%,Ⅲ度盗血占20%。基底动脉（BA）参与盗血6例,大脑后动脉参与盗血2例。5例SSS患者颅内椎动脉Ⅱ度盗血,而颅外椎动脉Ⅲ度盗血;③94例患者中有15例患者分别于6～18内个月进行了随诊,有1例患者盗血程度加重,1例患者出现新的盗血途径。11例行DSA检查的患者中,只有4例经TCD检查示椎动脉Ⅲ度盗血的患者,在DSA中能观察到血流从对侧椎动脉反向流入狭窄侧椎动脉最后到狭窄侧远端锁骨下动脉的全过程。而其余7例TCD检查示椎动脉Ⅰ、Ⅱ度盗血的患者,DSA仅能看到部分血流逆转过程或仅表现为患侧椎动脉显影稍淡或正常。4例患者行血管内支架术治疗,在第18个月随访时,4例均无临床症状复发,2例TCD表现复发。结论①TCD是观察SSS现象及盗血程度的敏感可靠的方法,且能判断颅内基底动脉、大脑后动脉受影响的情况,能使更多的SSS患者及时得到正确诊断。②TCD经济,方便,无创,准确,可用于评价动脉内支架置入术的治疗效果及长期随诊。     

椎-基底动脉窗式变异的螺旋CT血管成像诊断

目的探讨多层螺旋CT血管成像(CTA)对椎动脉和基底动脉窗式变异的无创性诊断价值。方法回顾性分析13例经DSA检查证实的椎动脉和基底动脉窗式变异的CTA资料,以DSA为标准,评价CTA检查在椎动脉和基底动脉窗式变异中的准确性。结果 13例患者共发现椎动脉或基底动脉窗式变异13个,CTA检查在窗式变异的部位、形态及范围的显示上与DSA检查结果完全一致。结论 CTA是一种高度准确、非侵袭性的成像技术,在椎-基底动脉窗式变异的诊断中有较高的应用价值。     

优化椎动脉造影在基底动脉穿支血管显示中的应用研究

目的：评价优化椎动脉造影显示基底动脉穿支血管的效果,以避免在神经介入术中损害相关后循环穿支动脉。 方法：选取2017年3月-7月在我院行后循环全脑数字减影血管造影（DSA）检查的患者共80例,并随机分为对照组40例（常规椎动脉造影）和实验组40例（优化椎动脉造影）。造影后在不同模式下观测基底动脉以及双侧大脑后动脉,确定能否辨认穿支动脉,并统计两组每段穿支数目的不同。 结果：两组造影后穿支动脉进行对比,发现实验组大脑后动脉P1段穿支动脉左、右侧分别为2.00±1.01和1.95±1.10支,对照组P1段左、右侧穿支动脉为1.52±0.71和1.45±0.81支;实验组P2段左、右侧穿支动脉为1.45±0.99和1.43±1.15支,对照组P2段左、右侧穿支动脉为0.78±0.65和0.55±0.55支;实验组基底动脉左、右侧脑桥穿支动脉为1.87±0.88和1.80±1.07支,对照组基底动脉左、右侧脑桥穿支动脉为0.37±0.54和0.28±0.50支;对照组观察所得各部位穿支动脉少于实验组,差异均有统计学意义（P<0.05）。 结论：全脑数字血管造影中,经优化的椎动脉造影方法能够更有效地显示出后循环穿支动脉的数量,更好地观察穿支动脉走行,可以指导神经介入手术,防止术中损害相关穿支动脉。     

Treatable lesions demonstrated on vertebral angiography for posterior circulation ischaemic events.

Angiography after a posterior circulation ischaemic event is often not considered because of the perception that it will not alter patient management. We identified 53 patients investigated with vertebral angiography over a 5 year period. This was significantly abnormal in 32 patients (60%). Five (9%) had vertebral artery dissections, nine (17%) had unilateral vertebral artery occlusion, two had a basilar artery disease. 16 (30%) had vertebral artery stenosis. 12 stenoses were considered suitable for percutaneous transluminal angioplasty (23%). 11 patients were anticoagulated (21%). There was no significant correlation between clinical features, site of infarct or the presence of carotid stenosis that would have allowed the prediction of the findings in the posterior circulation. Our results indicate that using vertebral angiography to investigate posterior circulation ischaemia will identify a significant number of potentially treatable lesions.     

症状性椎基底动脉狭窄的内支架成形术

目的　研究内支架成形术治疗症状性椎基底动脉狭窄的效果和安全性。方法　 2 0 0 1年 6月至 2 0 0 2年 4月间 ,16例症状性椎基底动脉狭窄患者接受了成形术。结果　 7例为一侧椎动脉狭窄、对侧椎动脉狭窄或闭塞 ,7例为优势侧椎动脉狭窄或对侧椎动脉仅供血小脑后下动脉区域 ,1例为基底动脉狭窄 (孤立性后组循环 ) ,1例为狭窄的椎动脉直接与小脑后下动脉延续。狭窄段位于椎动脉开口部 10例 ,位于颅内段 6例 ,1例患者为椎动脉近端 2处狭窄。MoriA型病变 12例 ,B型病变 3例 ,C型病变 1例。全组技术成功率 10 0 % ,平均狭窄率从 73.2 % (5 0 %～ 95 % )下降到 5 .1% (0～ 30 % ) ,P <0 .0 1。在围手术期内无严重并发症发生。随访 1～ 12个月 (平均 4 .4个月 ) ,按Malek评分 ,疗效极好 15例 ,疗效较好 1例。结论　对症状性基底动脉狭窄进行内支架成形术是安全和有效的方法 ,但长期疗效需要进一步积累病例和随访研究。     

Prevalence study of proximal vertebral artery stenosis using high-resolution contrast-enhanced magnetic resonance angiography

PURPOSE: To evaluate the prevalence of proximal vertebral artery stenosis, compared wiith those of the distal vertebral/basilar artery and extracranial internal carotid artery, in a large population of stroke and non-stroke patients. MATERIAL AND METHODS: Nine-hundred-and-thirty-five patients who underwent high-resolution contrast-enhanced magnetic resonance angiography in a regional general hospital were categorized into six groups based on neurological symptoms and disease: an asymptomatic group (n = 182), a minor symptom group with headache or dizziness (n = 519), a cardiac group with coronary artery steno-occlusive disease (n = 15), a hemorrhagic group with old cerebral hemorrhage (n=26), an anterior circulation infarct group (n = 121), and posterior circulation infarct group (n = 72). Prevalence of stenosis of the proximal vertebral artery, distal vertebral/basilar artery, and internal carotid artery was analyzed. RESULTS: The prevalence of stenosis of the proximal vertebral artery, distal vertebral/ basilar artery, and internal carotid artery was 12.9%, 5.5%, and 7.2%, respectively, in the study population, and rose as the age increased (P < 0.0001 for all arteries). The prevalence of stenosis of the proximal vertebral artery, distal vertebral/basilar artery, and internal carotid artery was 3.3%, 0.5%, and 1.1%, respectively, in the asymptomatic group; 8.3%, 2.1%, and 3.7%, respectively, in the minor symptom group; 13.3%, 6.7% and 6.7%, respectively, in the cardiac group; 19.2%, 7.7%, and 7.7%, respectively, in the hemorrhagic group; 27.3%, 8.3%, and 25.6%, respectively, in the anterior circulation infarct group; and 44.4%, 36.1%, and 16.7%, respectively, in the posterior circulation infarct group. This increasing tendency of stenosis accordingly was statistically significant (P < 0.0001 for all arteries). CONCLUSION: The prevalence of proximal vertebral artery stenosis was highest, compared with those of the distal vertebral/basilar artery and internal carotid artery, although the clinical significance of proximal vertebral artery stenosis should be investigated in further studies.     

椎动脉发育不良的螺旋CT血管造影诊断

目的探讨椎动脉发育不良的螺旋CT血管造影(spiralCTangiography,SCTA)表现和临床意义。方法180例临床诊断为椎-基动脉供血不足患者行SCTA检查。造影剂为浓度350mg/100ml的Omnipaque80～100ml,足背静脉注射。流率3ml/s,延迟时间由预扫描确定。层厚、间隔分别为3mm和4.5mm。重建间隔1.5mm。采用多平面容积重建(MPVR)和表面遮盖法重建(SSD),用原始横断面图像测量椎动脉直径。CT显示有椎动脉狭窄者于1周内行DSA检查。结果360根椎动脉中共发现78根(21.7%)有全程狭窄,平均直径1.3mm(1.0～1.5mm)。其中左侧24根,右侧54根。其中有20根同时伴有局限性进一步狭窄。对侧椎动脉合并局部管壁钙化13根(16.7%),合并V1段扭曲20根(25.6%),合并钩椎关节增生压迫11根(14.1%)。DSA检查结果与SCTA完全一致。结论椎动脉发育不良是椎-基动脉供血不足的常见原因之一,SCTA可以确诊并能取代诊断性DSA检查。     

Bilateral vertebral artery balloon occlusion for giant vertebrobasilar aneurysms

We describe the clinical presentation, radiological and clinical results in six consecutive patients with a giant vertebrobasilar aneurysm treated by bilateral vertebral artery balloon occlusion. Five patients presented with headache and signs of brain-stem compression and one with subarachnoid haemorrhage. In all patients vertebral artery balloon occlusion was performed. In four, this followed successful test occlusion. In one patient, who did not tolerate the test occlusion, a bypass from the external carotid to the posterior cerebral artery preceded definitive vertebral artery occlusion. One patient underwent bypass surgery prior to test occlusion. At 6–22 months follow-up three patients had a good functional outcome and showed unchanged size or shrinkage of the aneurysm on MRI. Three other patients died; one from recurrent haemorrhage, and two probably from delayed brain-stem ischaemia. The presence of two large posterior communicating arteries predicted good functional outcome, which was also related to the clinical condition at presentation, and the degree of brain-stem compression and oedema on MRI. Bilateral vertebral artery balloon occlusion can be considered in patients with otherwise untreatable giant vertebrobasilar aneurysms. If test occlusion is not tolerated, a surgical bypass to the posterior circulation can be considered. Received: 1 December 1999 Accepted: 6 October 2000     

经皮腔内血管成形和支架植入术治疗椎基底动脉狭窄

目的　探讨经皮腔内血管成形和支架植入术治疗椎基底动脉狭窄的效果和安全性。方法　 2 0 0 3年 4月至 2 0 0 4年 6月间 ,2 8例椎基底动脉狭窄患者进行了经皮腔内血管成形和支架植入术治疗。结果　 2 8例患者 ,18例为优势侧椎动脉狭窄 ,4例为双侧椎动脉狭窄 ,3例为一侧椎动脉狭窄、对侧椎动脉闭塞 ,1例为串联狭窄 ,2例为基底动脉狭窄。狭窄段位于椎动脉开口 7例 ,位于颈部椎动脉 2例 ,位于颅内段 17例。MoriA型病变 2 4例 ,B型病变 3例 ,C型病变 1例。全组技术成功率 10 0 % ,术前2 8例平均狭窄率为 81.3% ,术后残余狭窄率均 <10 % ,(P <0 .0 1)。所有病例在围手术期内均未发生严重并发症。本组随访 17例患者 ,时间为 6个月 ,Malek评分为 1分者 15例 ,2分者 2例。DSA脑血管造影复查 3例均未见支架内再狭窄。结论　经皮腔内血管成形和支架植入术是治疗椎基底动脉供血不足 ,预防椎基底动脉系统卒中的安全、有效方法 ;近期预后良好