症状性双侧椎动脉闭塞侧支代偿与预后分析

【摘要】
目的 探讨症状性双侧椎动脉闭塞患者侧支代偿与临床表现及预后的关系。
方法 本研究采用回顾性研究方法，连续纳入2006年9月～2011年11月首都医科大学附属天坛医院收住的双侧椎动脉闭塞患者共10例，收集患者的临床资料、侧支代偿分级及预后情况，分析侧支代偿与预后的关系。
结果 双侧椎动脉闭塞患者脑梗死发生比例高（6/10），病情重，预后差（mRS≥3，5/10）。闭塞病变多位于椎动脉V1段起始处（13/20），其次是V4段（6/20），V3段（1/20）。侧支代偿不充分组入院时及随访结束时脑梗死所占比例较侧支代偿充分组均较高（2/4 vs 4/6；2/4 vs 5/6），差异无显著性（P=0.43，P=0.30）。侧支代偿不充分组较代偿充分组入院病情重（mRS≥3者分别为1/4 vs 4/6；NIHSS评分≥4者分别为0/4 vs 1/6；P=0.24，P=0.60），预后差（mRS≥3者分别为1/4 vs 4/6），差异无显著性（P=0.24）。
结论 双侧椎动脉闭塞患者发生脑梗死比例高，病情重，预后差。侧支代偿程度可能影响双侧椎动脉闭塞患者的临床表现。

Symptomatic Bilateral Vertebral Artery Occlusion Collateral Compensatory and Prognosis Analysis

【Abstract】
Objective To analyze the clinical characteristics of patients with bilateral vertebral artery occlusion, and explore its collateral compensatory relationship with clinical manifestation and prognosis.
Methods Ten patients with bilateral vertebral artery occlusion admitted to our hospital between September 2006 and November 2011 were retrospectively studied. Clinical data, collateral compensatory grading and prognosis were collected. Collateral circulation and prognosis were analyzed.
Results Patients with bilateral vertebral artery occlusion had a high cerebral infarction incidence (6/10), in a critical condition, with poor prognosis (mRS3, 5/10). Occlusion lesions were more likely to occur in V1 segment of the vertebral arteries (13/20), then following V4 segment (6/20) and V3 segment (1/20). Compared with the sufficient collateral compensatory group, the proportions of cerebral infarction were higher in insufficient collateral compensatory group on admission and during the follow-up (2/4 vs 4/6; 2/4 vs 5/6), but there were no significant differences between both groups (P=0.43, P=0.30). The illness was more serious in the insufficient collateral compensatory group (mRS3, 1/4 vs 4/6; NIHSS4, 0/4 vs 1/6; P=0.24, P=0.60) and its long-term prognosis was poorer (mRS3, 1/4 vs 4/6, P=0.24), and there were no significant differences between both groups.
Conclusion Patients with bilateral vertebral artery occlusion have a high cerebral infarction incidence, in a critical condition, with poor prognosis. Collateral compensation levels may affect clinical manifestations of patients with bilateral vertebral artery occlusion.