机械取栓治疗椎基底动脉急性闭塞合并串联病变的轻型卒中一例

A Case of Mechanical Thrombectomy for Acute Vertebrobasilar Artery Occlusion with Tandem Lesions in a Patient with Mild Stroke

摘要: 患者因走路不稳、言语不清12小时，加重7小时余入院。院外颅脑MRA双侧椎动脉及基底动脉未见显影，为行进一步治疗，行数字减影血管造影(Digital subtraction angiography, DSA)检查：左侧椎基底动脉串联病变，急行机械取栓与支架植入治疗，患者病情稳定后出院。急性椎基底动脉闭塞引起的后循环缺血性卒中具有高死亡率和发病率，但目前对椎基底动脉串联闭塞的发病率和血管内介入治疗的效果尚有争议。其发病机制大多是由于动脉粥样硬化导致。部分患者的始发表现为眩晕、恶心、呕吐、共济失调等症状，患者四肢肌力可能并不会受影响，但随着斑块破损，栓子不断脱落，患者会出现四肢瘫，意识障碍，呼吸心跳衰竭等症状，严重时会危及患者生命。

Abstract: The patient was admitted with unsteady gait and slurred speech for twelve hours, which had worsened over the preceding seven hours. Extracranial magnetic resonance angiography (MRA) revealed no visualization of the bilateral vertebral arteries or the basilar artery. To further evaluate, digital subtraction angiography (DSA) was performed, showing tandem lesions of the left vertebrobasilar artery. Emergency mechanical thrombectomy combined with stent implantation was performed. The patient was discharged in stable condition after treatment. Acute ischemic stroke caused by vertebrobasilar artery occlusion carries a high rate of morbidity and mortality. However, the incidence of vertebrobasilar tandem occlusion and the efficacy of endovascular treatment remain controversial. The underlying pathogenesis is most commonly related to atherosclerosis. Some patients initially present with vertigo, nausea, vomiting, or ataxia, while motor strength of the limbs may remain intact. With plaque rupture and recurrent embolization, patients may develop quadriplegia, impaired consciousness, or cardiopulmonary failure, which can be life-threatening. Here, we report a case of ischemic stroke caused by vertebrobasilar tandem lesions and provide a brief review of the literature. The aim is to improve clinicians’ understanding of this condition and to offer insight into the diagnosis and treatment of mild stroke resulting from vertebrobasilar occlusion.