Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Neurosurgery. 2010 Apr;66(4):825-31; discussion 831-2. doi: 10.1227/01.NEU.0000367611.78898.A3.
Occlusion of the basilar artery (BA) has a poor prognosis. We evaluated technical considerations and complications associated with reopening subacute to chronically occluded BAs.
Duration of BA occlusion before revascularization, symptoms and medical management before treatment, and postprocedural antiplatelet regimen and anticoagulation protocols of 9 patients were analyzed. All patients underwent endovascular low-volume balloon angioplasty followed by Wingspan stenting.
The median time between onset of symptoms and treatment was 5 days (range, 2 days to 3.5 years). The median time between documentation of BA occlusion by cerebral angiography or computed tomography angiography and treatment was 3 days (range, 1 day to 8 months). Recanalization was successful in 8 of the 9 patients. Immediately after the procedure, 4 patients were stable, 3 patients improved, and 2 patients were worse. Four patients had periprocedural complications. Four of the 9 patients died, 2 from periprocedural complications. The mean clinical duration of follow-up was 11 months. At latest follow-up, the modified Rankin Scale scores for the 5 surviving patients were 0, 0, 2, 2, and 3, respectively. During the follow-up period, 4 patients improved, 1 patient remained stable, and 1 patient died. The mean angiographic follow-up was 8.6 months. Two patients developed significant in-stent stenosis during this period.
With current endovascular techniques, recanalization of chronically occluded BAs is feasible. The procedure carries substantial risks and should be reserved for patients with medically refractory symptoms. Careful postprocedural medical management and radiographic follow-up are warranted to prevent in-stent restenosis.
基底动脉（BA）闭塞的预后较差。我们评估了与再通亚急性至慢性闭塞 BA 相关的技术考虑因素和并发症。
分析了 9 例患者的 BA 闭塞前再通时间、治疗前症状和药物治疗、术后抗血小板方案和抗凝方案。所有患者均接受血管内低容量球囊血管成形术，随后进行 Wingspan 支架置入术。
症状发作与治疗之间的中位数时间为 5 天（范围为 2 天至 3.5 年）。从 BA 闭塞的脑血管造影或 CT 血管造影记录到治疗的中位数时间为 3 天（范围为 1 天至 8 个月）。9 例患者中有 8 例再通成功。手术后即刻，4 例患者稳定，3 例患者改善，2 例患者恶化。4 例患者发生围手术期并发症。9 例患者中有 4 例死亡，2 例死于围手术期并发症。9 例患者的平均临床随访时间为 11 个月。在最新的随访中，5 例存活患者的改良 Rankin 量表评分分别为 0、0、2、2 和 3。在随访期间，4 例患者病情改善，1 例患者病情稳定，1 例患者死亡。平均血管造影随访时间为 8.6 个月。在此期间，2 例患者发生明显支架内狭窄。
目前的血管内技术可使慢性闭塞的 BA 再通。该手术风险较大，应仅保留给药物治疗无效的症状患者。应进行仔细的术后药物治疗和影像学随访，以防止支架内再狭窄。
