Rasmussen P A, Perl J, Barr J D, Markarian G Z, Katzan I, Sila C, Krieger D, Furlan A J, Masaryk T J
Department of Neurosurgery, Cleveland Clinic Foundation, Ohio 44195, USA.
J Neurosurg. 2000 May;92(5):771-8. doi: 10.3171/jns.2000.92.5.0771.
Patients with intracranial vertebrobasilar artery (VBA) atherosclerotic occlusive disease have few therapeutic options. Unfortunately, VBA transient ischemic attacks (TIAs) herald a lethal or devastating event within 5 years in 25 to 30% of patients. The authors report their initial experience with eight patients in whom medically refractory TIAs secondary to intracranial posterior circulation atherosclerotic occlusive lesions were treated with stent-assisted angioplasty.
Eight patients (six men), ranging in age from 43 to 77 years, experienced signs and symptoms of VBA insufficiency despite combination therapy with warfarin and antiplatelet agents. Angiographic studies revealed severe distal vertebral (four patients), proximal basilar (one patient), or proximal and midbasilar stenoses (three patients). Aspirin and clopidogrel were administered for 3 days before primary angioplasty and stent placement, and this regimen was maintained by the patients on discharge. Patients underwent heparinization during the procedure and were given a bolus and 12-hour infusion of abciximab. A neurologist specializing in stroke evaluated all patients before and after the procedure. The VBAs in all patients were successfully revascularized with 7 to 28% residual stenosis. Six patients experienced no neurological complications. One patient died the evening of the procedure due to a massive subarachnoid hemorrhage. Two patients had groin hematomas, one developed congestive heart failure, and one had transient encephalopathy. All surviving patients are asymptomatic up to 8 months postoperatively.
Although primary intracranial VBA angioplasty with stent insertion is technically feasible, complications associated with the procedure can be life threatening. As experience is gained with this procedure, it may be offered routinely as an alternative therapy to patients with medically refractory posterior circulation occlusive disease that may develop into catastrophic VBA insufficiency.
颅内椎基底动脉（VBA）粥样硬化闭塞性疾病患者的治疗选择有限。不幸的是，25%至30%的VBA短暂性脑缺血发作（TIA）患者会在5年内发生致死性或致残性事件。作者报告了他们对8例因颅内后循环粥样硬化闭塞性病变导致药物难治性TIA患者进行支架辅助血管成形术的初步经验。
8例患者（6例男性），年龄43至77岁，尽管联合使用了华法林和抗血小板药物，但仍出现VBA供血不足的体征和症状。血管造影研究显示严重的椎动脉远端狭窄（4例患者）、基底动脉近端狭窄（1例患者）或基底动脉近端和中段狭窄（3例患者）。在初次血管成形术和支架置入术前3天给予阿司匹林和氯吡格雷，出院后患者继续维持该用药方案。术中患者接受肝素化，并给予阿昔单抗推注和12小时输注。一名专门从事卒中治疗的神经科医生对所有患者在手术前后进行了评估。所有患者的VBA均成功实现血管再通，残余狭窄率为7%至28%。6例患者未出现神经并发症。1例患者在术后当晚因大量蛛网膜下腔出血死亡。2例患者出现腹股沟血肿，1例发生充血性心力衰竭，1例出现短暂性脑病。所有存活患者术后8个月均无症状。
尽管颅内VBA初次血管成形术并置入支架在技术上是可行的，但该手术相关并发症可能危及生命。随着对该手术经验的积累，对于可能发展为灾难性VBA供血不足的药物难治性后循环闭塞性疾病患者，可将其作为常规替代治疗方法。
