Kim B M, Suh S H, Park S I, Shin Y S, Chung E C, Lee M H, Kim E J, Koh J S, Kang H-S, Roh H G, Won Y S, Chung P-W, Kim Y-B, Suh B C
Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea.
AJNR Am J Neuroradiol. 2008 Nov;29(10):1937-41. doi: 10.3174/ajnr.A1243. Epub 2008 Aug 7.
There have been inconsistencies on the prognosis and controversies as to the proper management of acute basilar artery dissection. The aim of this study was to evaluate acute basilar artery dissection and its outcome after management.
A total of 21 patients (mean age, 53 years; range, 24-78 years) with acute basilar artery dissection were identified between January 2001 and October 2007. Clinical presentation, management, and outcomes were retrospectively evaluated.
The patients presented with subarachnoid hemorrhage (n = 10), brain stem ischemia (n = 10), or stem compression sign (n = 1). Ruptured basilar artery dissections were treated by stent placement with coiling (n = 4), single stent placement (n = 3), or conservatively (n = 3). Of the patients treated with endovascular technique, 6 had favorable outcome (modified Rankin scale [mRS], 0-2) and the remaining patient, who was treated by single stent placement, died from rebleeding. All 3 conservatively managed patients experienced rebleeding, of whom 2 died and the other was moderately disabled. Unruptured basilar artery dissections were treated conservatively (n = 7) or by stent placement (n = 4). Of the patients with unruptured basilar artery dissection, 9 had favorable outcome and the remaining 2 patients, both of whom were conservatively managed, had poor outcome because of infarct progression. The group with the ruptured basilar artery dissection revealed a higher mortality rate than the group with the unruptured dissection (30% vs 0%). The group treated with endovascular means revealed more favorable outcome than the group that was treated with conservative measures (90.9% vs 50%).
The ruptured basilar artery dissections were at high risk for rebleeding, resulting in a grave outcome. Stent placement with or without coiling may be considered to prevent rebleeding in ruptured basilar dissections and judiciously considered in unruptured dissections with signs of progressive brain stem ischemia.
急性基底动脉夹层的预后存在不一致性，其恰当的治疗方法也存在争议。本研究的目的是评估急性基底动脉夹层及其治疗后的结局。
2001年1月至2007年10月期间共确定了21例急性基底动脉夹层患者（平均年龄53岁；范围24 - 78岁）。对临床表现、治疗方法及结局进行回顾性评估。
患者表现为蛛网膜下腔出血（n = 10）、脑干缺血（n = 10）或脑干压迫体征（n = 1）。破裂的基底动脉夹层采用支架置入联合弹簧圈栓塞治疗（n = 4）、单纯支架置入治疗（n = 3）或保守治疗（n = 3）。在采用血管内技术治疗的患者中，6例预后良好（改良Rankin量表[mRS]评分为0 - 2），其余1例采用单纯支架置入治疗的患者死于再出血。所有3例保守治疗的患者均发生再出血，其中2例死亡，另1例中度残疾。未破裂的基底动脉夹层采用保守治疗（n = 7）或支架置入治疗（n = 4）。在未破裂基底动脉夹层患者中，9例预后良好，其余2例均采用保守治疗，因梗死进展预后较差。破裂基底动脉夹层组的死亡率高于未破裂夹层组（30%对0%）。采用血管内治疗的组比采用保守治疗的组预后更良好（90.9%对50%）。
破裂的基底动脉夹层再出血风险高，导致严重后果。对于破裂的基底动脉夹层，可考虑采用支架置入联合或不联合弹簧圈栓塞以预防再出血，对于有进行性脑干缺血体征的未破裂夹层，可审慎考虑采用该方法。
