Turliuk D V, Ianushko V A, Kardash O F
Republican Research and Practical Centre Cardiology, Minsk, Belarus. dimaman@tulby
Angiol Sosud Khir. 2009;15(4):98-105.
To determine efficacy of surgical management for vertebrobasilar insufficiency (VBI) associated with pathological passage of the vertebral artery (VA) within the bone canal.
Over the period from 2003 to 2008, a total of twenty-five patients with no effect of conservative therapy during 6 months were subjected to reconstruction of the VA in the 3rd segment. The access to the artery was obtained in a manner similar to that used in reconstruction of the carotid arteries, without intersecting the nodding muscle. All the patients were prior to surgery subjected to neuropsychological testing, extra-and intracranial ultrasonographic study with the positional tests, angiography (NMR or digital subtraction angiography). Doppler ultrasonography of the bypass graft, neuropsychological testing, and angiography by the indications were repeated on postoperative day 7 and 3 months after surgery.
In the postoperative period according to the VBI scale and Tinneti scale, we revealed significant improvement of the indices on day 7. The improvement of the cognitive functions was not statistically significant (P >0.05). Transcranial Doppler ultrasonography with the De Kleijn test at baseline revealed that five (21%) patients had a complete arrest of blood circulation along one of the VAs, with a decrease in the blood flow along the basilar artery by more than 50%. In the remaining cases, the difference in the volumetric characteristics of the blood stream along the basilar artery averagely amounted to 42.0 +/- 5.4%. Ultrasonographic study performed both in the short- and long-term postoperative periods (on day 7, at 3 months) did not reveal any significant decrease in the bloodflow along the basilar artery during the positional test.
The external-carotid--vertebral transposition improves the blood circulation in the posterior cranial fossa. An operative intervention performed on the 3rd segment of the vertebral artery removes symptomatology of VBI as early as in the immediate postoperative period. Poor surgical outcomes in hypoplasia of the vertebral artery require further studies aimed at investigating the possibilities of surgical correction of VBI in patients presenting with the vascular pathology concerned.
确定手术治疗与椎动脉（VA）在骨管内病理性走行相关的椎基底动脉供血不足（VBI）的疗效。
在2003年至2008年期间，共有25例在6个月保守治疗无效的患者接受了第三段椎动脉重建术。采用与颈动脉重建术类似的方式暴露动脉，不切断斜方肌。所有患者在手术前均接受了神经心理学测试、颅内外超声检查及体位试验、血管造影（核磁共振或数字减影血管造影）。术后第7天和术后3个月，根据指征重复进行旁路移植血管的多普勒超声检查、神经心理学测试和血管造影。
术后根据VBI量表和Tinetti量表，我们发现术后第7天各项指标有显著改善。认知功能的改善无统计学意义（P>0.05）。基线时经颅多普勒超声检查及De Kleijn试验显示，5例（21%）患者一侧椎动脉血流完全停滞，基底动脉血流减少超过50%。其余病例中，基底动脉血流容积特征的差异平均为42.0±5.4%。术后短期和长期（术后第7天、3个月）进行的超声检查未发现体位试验期间基底动脉血流有任何显著减少。
颈外动脉-椎动脉转位可改善后颅窝血液循环。对椎动脉第三段进行手术干预可在术后早期消除VBI症状。椎动脉发育不全时手术效果不佳，需要进一步研究，以探讨对患有相关血管病变的VBI患者进行手术矫正的可能性。
