中国脑血管病杂志2012，Vol.9Issue(4)：169-173,5.DOI:10.3969/j.issn.1672-5921.2012.04.001
椎-基底动脉夹层的临床特点和治疗
Clinical characteristics and treatment for vertebral basilar artery dissection
摘要
Abstract
Objective To investigate the clinical characteristics, therapeutic strategies and efficacy of vertebral basilar artery dissection (VAD). Methods Twenty-eight patients with VAD diagnosed by DSA or CTA were collected. 21 of the patients wilh posterior circulation ischemia (PCI) were treated with clopidogrel (75 mg/d) or aspirin (100 mg/d) alone, 3 underwent endovascular treatment, and 2 with sub-arachnoid hemorrhage (SAH) were treated with stent-assisted coil embolization of the aneurysms and vertebral artery occlusion. The clinical characteristics and follow-up results were analyzed. Results ①In the 28 patients, 24 had clear causes or incentive factors, including abnormal movement of the head and neck (15/24, 53.6% ), atherosclerosis (4/24, 16.7%), upper respiratory tract infection (12.5% , 3/24), thrombocytosis (4. 2% , 1/24), and alcoholism (4.2% , 1/24); 4 were cryptogenic. ② In the 28 patients, 25 (89.3% ) had PCI (21 of them had posterior circulation infarct, 4 had repeated transient episodes of vertigo), and 3 patients( 10.7% ) had SAH. ③DSA or CTA showed that 30 vertebral arteries and 1 basilar artery had dissection, 16 (51.6%) showed "linear sign", 9 (29.0%) showed fusiform or saccular aneurysm6, 6(19.4%) showed "pearl and string sign", and 2(6.5%) had double-lumen sign. Most dissections were oc-cured in the V4 segments (71.0% ,up to 22/31), then Mowed by V2 segments (19.4% , 6/31). ④In the 25 patients with PCI, 21 were treated with medication, 19 had good and 2 had poor prognosis. 9 patients received CTA or DSA reexamination, the degree of vascular stenosis reduced in 4 patients, no significant change in 4 patients, and 1 patient's vertebral artery was occluded. Three patients treated with endovascular treatment, and their prognosis was good. CTA reexamination no vascular restenosis or aneurysm recurrence was found. Two of the 3 patients with SAH had good prognosis. CTA reexamination showed no recurrence of aneurysms; 1 patient was only treated with medication because his family members refused surgery. He was died of recurrent subaraehnoid hemorrhage. Conclusion Different therapeutic strategy must be adopted according to the different clinical characteristics of the patients with VAD, most patients will have a good prognosis.关键词
椎动脉/基底动脉/夹层/后循环缺血/疾病特征/治疗Key words
Vertebral artery/ Basilar artery/ Dissection/ Ischemia, posterior circulation/ Disease attributes/ Therapy引用本文复制引用
郑峥,程琼,李永坤,刘君鹏,陈莹,汪银洲..椎-基底动脉夹层的临床特点和治疗[J].中国脑血管病杂志,2012,9(4):169-173,5.基金项目
福建省卫生厅青年科研课题资助项目(2009-2-4) （2009-2-4）
