基底动脉的显微解剖与血管造影对照观测及临床应用

目的　为选择血管支架的类型和放置部位提供解剖学基础。 方法 （1）选取头部标本20例，经斜坡入路解剖观测基底动脉及其分支、穿支血管。（2）选取无病变的全脑血管造影像100例，观测基底动脉的走行、分支及其穿支的开口部位。（3）选取基底动脉狭窄患者20例，经股动脉穿刺施行支架成形术，观测基底动脉狭窄部位的血管直径和血管狭窄的变化。 结果 基底动脉的长度和外径分别为　(28.52±3.45) mm、(4.52±0.24) mm，血管造影长度和直径分别为(25.47±3.65) mm、(3.46±0.46) mm，显微解剖与血管造影有显著性差异（P<0.05）。基底动脉的穿支细小、密集，从基底动脉后外侧壁发出后直行进入脑实质。基底动脉血管造影的横径与前后径之间有显著性差异（P<0.05），基底动脉内腔呈椭圆形。男、女性基底动脉血管造影的长度和直径有显著性差异（P<0.05），男性较女性的基底动脉长，直径粗。基底动脉支架成形术的手术成功率为100%，狭窄血管的直径有明显改善。 结论 基底动脉的显微解剖与血管造影对照观测对选择血管支架的类型和放置部位，防止术后穿支供应区域缺血等具有重要的临床意义。

Microanatomic and angiographic observation of the basilar artery and its clinical application

Objective　To provide anatomical basis for selecting the types and the placing parts of vascular stent.　Methods　(1)20 head specimens were selected and measured for the basilar artery , its branches, and perforators through the clivus approach. (2)100 angiographic images of the whole brains without diseases were selected, the course, branches of the basilar artery and the opening parts of its perforators were observed. (3)20 patients of basilar artery stenosis were selected and underwent stent angioplasty through puncture at the femoral artery, the changes of the vascular diameter in the stenosed parts of the basilar artery were measured.　Results　The basilar artery was (28.52±3.45) mm in length, (4.52±0.24) mm in external diameter in microanatomic observation, and (25.47±3.65) mm, (3.46±0.46) mm in length and diameter in angiographic observation. There were significant difference in length and diameter between the microanatomy and angiography,respectively (P<0.05). The perforators of basilar artery were fine, small and concentrated, which originated from the posterolateral wall of the basilar artery and enter the brain parenchyma in straight courses. There were significant difference in the transverse and anteroposterior diameter the basilar artery in angiographic view (P<0.05). The lumen of the the basilar artery was elliptical in shape. There were significant difference in length and diameter between males and females of the basilar artery in angiographic view, respectively (P<0.05), the male basilar artery were longer and thicker than that of the female. Operative success rate for stent angioplasty of the basilar artery was 100%; There was clear improvement in stenosis.of the blood vessels.　Conclusion　 It is of enormous clinical significance for selecting the types and the placing parts of the vascular stent so that postoperative ischemia of the supply area of perforators can be prevented