后循环血管重建手术治疗椎基底动脉闭塞疗效初探

目的探讨后循环血管重建手术治疗双侧椎动脉或基底动脉闭塞的术式选择和疗效。方法分别采用枕动脉小脑后下动脉、颞浅动脉小脑上动脉、颞浅动脉大脑后动脉,以及移植桡动脉行枕动脉椎动脉寰椎上段吻合术等术式治疗9例双侧椎动脉或基底动脉闭塞患者。结果术中吲哚菁绿荧光血管造影显示所有患者吻合血管形态良好、血流通畅;术后第7天脑血管造影检查,8例吻合血管血流通畅、1例吻合血管未显影,MR(或CT)灌注成像7例血流灌注明显改善。术后患者头晕症状完全消失(2例)、构音障碍减轻及吞咽功能好转(5例)。9例患者中仅1例于术后15d死于心肺功能衰竭,其余8例随访期间均未发生脑缺血症状,4例基本恢复正常生活。结论根据椎基底动脉闭塞部位选择相应后循环血管重建手术方式,初步结果显示效果良好,但仍需大样本随机对照研究予以验证。

Posterior circulation revascularization to mariage vertebrobasilar ogclusion

Objective To discuss the technique and effect of posterior circulation revascularization to manage vertebrobasilar occlusion.Methods Nine patients with vertebrobasilar occlusion were treated by using occipital artery posterior inferior cerebellar artery bypass,superficial temporal artery-superior cerebellar artery bypass,superficial temporal artery posterior cerebral artery bypass and occipital artery vertebral artery bypass with radial artery graft.Results Intraoperative indocyanine green angiography showed all the bypass arteries were patent.Postoperative DSA or CTA showed bypass arteries patent in 8 patients,among whom seven patients got obvious improvement on MR or CT perfusion.One patient died of heart failure on the 15th day postoperative.During the follow-up of eight patients,no stroke reoccurred,four patients got back to nearly normal life.Conclusion Most of the patients with vertebrobasilar occlusion could benefit from the posterior circulation revascularization,which should be confirmed by randomized controlled clinical trials in the future.