应用DSA诊断椎-基底动脉变异

目的探讨椎基底动脉变异的种类和发生率及DSA影像学特征,提高对椎基底动脉变异临床意义的认识。方法对6432例患者均进行全脑血管进行造影,对全脑血管造影的DSA图像资料进行回顾性分析,得出椎基底动脉变异的发生率及变异血管合并其他血管病变的情况。结果发生椎动脉起源变异272例患者278支椎动脉,检出率为4.3%,其中左椎动脉起源异常270支(4.2%),右椎动脉起源异常8支;左椎动脉起源异常中,258支直接起自主动脉弓,2例为双起源椎动脉,4支起自颈内动脉,6支起自左锁骨下动脉根部。8支右椎动脉起源异常中,2支直接起源于右颈总动脉,2支起自右颈内动脉动脉,2例为双起源椎动脉,2支直接起自头臂干动脉。141例椎基底动脉成窗(2.19%);61支小脑后下动脉起自颅外段位置较低部位。11例永久性原始三叉动脉。另外,有9例变异结构的远端或近端伴发动脉瘤、2例伴发动静脉畸形。7例出现与成窗结构供血区相一致的一过性脑缺血症状,其中2例出现经成窗结构远端供血部位的脑梗塞,1例出现经双起源椎动脉供血部位的脑梗塞。结论脑血管DSA可以清晰显示椎基底动脉变异的位置、形态、毗邻关系及有无伴发其他血管性病变;掌握椎基底动脉变异的DSA影像学表现及血流动力学特征,对脑血管病的明确诊断及手术和介入治疗方案的制定具有重要临床意义。

Diagnosis of vertebral basilar artery variation with digital subtraction angiography

Objective This study is to investigate the prevalence of vertebral basilar artery veriation and its imaging characters in patients receiving cerebral artery digital subtraction angiography.Methods We reviewed 6432 patients receiving cerebral artery digital subtraction angiography,and got the prevalence of vertebral basilar artery veriation and associated cerebral artery diseases in these patients.Results Among the 6432 patients,4.2%（278vertebral arteries in 272cases）was diagnosed with anomalous origin of vertebral artery,including 4.2%of anomalous origin of the left vertebral artery（n=270,of which 258 vertebral arteries originated from the aortic arch,2cases were duplicitous origin of the left vertebral artery,4cases of vertebral artery originated from left internal carotid artery and 6vertebral arteries originated from the root of left subclavian artery）and 8were anomalous origin of the right vertebral artery（of which 2branches originated from right common carotid artery,2originated from right internal artery,2duplicitous origin of the right vertebral artery,2originated from brachiocephalic trunk）.61 branches of PCA originated from infraversion.The fenestrations of vertebral basilar artery were 141cases（2.19%）.Persistent trigeminal artery were 11cases（0.17%）.Among the fenestrations of cerebral artery,9cases were accompanied with aneurysms,2cases were accompanied with arteriovenous malformation.7cases were accompanied with cerebral ischemia,2cases accompanied with cerebral infarction.1case of duplicitous origin of the right vertebral artery was accompanied with cerebral infarction.Conclusion Cerebral artery digital subtraction angiography was able to show the location,morphology,adjacent relationship and associated vascular diseases in vertebral basilar artery fenestration.This could provide more information for the diagnosis and treatment of cerebrovascular diseases,especially for the neuroradiology intervention therapy.