症状性颅内椎–基底动脉非急性闭塞介入开通的疗效观察

Curative Effect Observation of Interventional Patency of Symptomatic Vertebrobasilar Artery Non-Acute Occlusion

摘要: 目的：探讨症状性颅内椎–基底动脉非急性闭塞介入开通的技术可行性、围手术期安全性及治疗效果。方法：回顾性分析两家大型区域性卒中中心2017年8月至2021年8月收治的非急性颅内椎–基底动脉闭塞患者资料。分析这些患者的基本资料，临床特征、影像学特征及随访资料，包括开通成功率、围手术期并发症发生率、临床随访资料及影像随访资料。采用脑梗死溶栓试验(thrombolysis in cerebral ischemia, TICI)分级评估是否开通成功，采用改良Rankin量表(mRS)评估术后神经功能恢复程度。结果：本文纳入41例患者，成功开通37例，占比90.24%，术后TICI分级较术前TICI分级差异有统计学意义(P < 0.05)；4例出现围手术期并发症，无死亡病例，发生率为9.75%。对37例成功开通患者进行90天临床随访，无复发性TIA或中风；mRS评分与术前相比明显改善，差异有统计学意义(P < 0.05)；1年临床随访时，有2例患者死亡(与手术无关)。35例患者mRS评分与术前相比差异有统计学意义(P < 0.05)。结论：经过选择的有症状的非急性颅内椎–基底动脉闭塞患者，介入开通技术上可行，围手术期并发症可以接受，随访患者临床症状改善明显。

Abstract: Objective: To investigate the technical feasibility, perioperative safety and therapeutic effect of in-terventional opening of symptomatic intracranial vertebrobasilar artery non-acute occlusion. Methods: The data of patients with non-acute intracranial vertebrobasilar artery occlusion admit-ted from August 2017 to August 2021 in two large regional stroke centers were analyzed retro-spectively. The basic data, clinical characteristics, imaging characteristics and follow-up data of these patients were analyzed, including the success rate of patency, perioperative complication rate, clinical follow-up data and imaging follow-up data. The thrombolysis in cerebral ischemia (TICI) grade was used to assess whether the opening was successful, and modified Rankin Scale (mRS) was used to assess the degree of postoperative neurological recovery. Results: Of the 41 pa-tients included in this study, 37 patients were successfully opened, accounting for 90.24%. There was a significant difference in postoperative TICI grading compared with preoperative TICI grading (P < 0.05); There were 4 cases with perioperative complications, no death, and the incidence rate was 9.75%. 37 patients who were successfully opened were followed up for 90 days, and there was no recurrent TIA or stroke; The mRS score was significantly improved compared with that before operation (P < 0.05); During one year of clinical follow-up, 2 patients died (unrelated to surgery). The mRS scores of 35 patients were significantly different from those before operation (P < 0.05). Conclusion: The selected symptomatic patients with non-acute intracranial vertebrobasilar artery occlusion are technically feasible, the perioperative complications are acceptable, and the clinical symptoms of follow-up patients are improved significantly.