Comerota A J, Maurer A H
Department of Surgery, Temple University Hospital, Philadelphia, Pa 19140.
Stroke. 1992 Apr;23(4):602-6. doi: 10.1161/01.str.23.4.602.
Incapacitating vertebrobasilar insufficiency is generally associated with bilateral vertebral artery disease, whereas unilateral vertebral artery stenosis usually is clinically silent. Regional brain perfusion has not been part of the routine evaluation of patients with vertebrobasilar insufficiency. This report describes two patients who had isolated unilateral vertebral artery stenosis operatively corrected to eliminate their incapacitating vertebrobasilar insufficiency. Hindbrain hypoperfusion was identified preoperatively and evaluated postoperatively, then correlated with patient presentation and response to revascularization.
Two patients with incapacitating vertebrobasilar insufficiency presented with isolated unilateral vertebral artery stenosis with patent, nonstenotic internal carotid arteries. Hindbrain hypoperfusion was demonstrated by iodine-123-iodoamphetamine single-photon emission computed tomography preoperatively and demonstrated significant improvement following vertebral-carotid reimplantation. The patients' symptoms resolved following revascularization.
Although unusual, unilateral vertebral artery stenosis can cause incapacitating vertebrobasilar insufficiency. These cases demonstrate the value of imaging with single-photon emission computed tomography to evaluate regional brain hypoperfusion and to evaluate objectively the results of therapy.
致残性椎基底动脉供血不足通常与双侧椎动脉疾病相关，而单侧椎动脉狭窄在临床上通常无症状。局部脑灌注尚未成为椎基底动脉供血不足患者常规评估的一部分。本报告描述了两名孤立性单侧椎动脉狭窄患者，通过手术矫正以消除其致残性椎基底动脉供血不足。术前识别并术后评估了后脑灌注不足情况，然后将其与患者表现及血运重建反应相关联。
两名致残性椎基底动脉供血不足患者表现为孤立性单侧椎动脉狭窄，颈内动脉通畅且无狭窄。术前通过碘-123-碘安非他明单光子发射计算机断层扫描证实存在后脑灌注不足，在椎动脉-颈动脉再植术后显示有显著改善。血运重建后患者症状消失。
尽管不常见，但单侧椎动脉狭窄可导致致残性椎基底动脉供血不足。这些病例证明了单光子发射计算机断层扫描成像在评估局部脑灌注不足及客观评估治疗效果方面的价值。
