Center for Neuroendovascular Therapy, Stroke Institute, Pittsburgh, PA 15213, USA.
J Neuroimaging. 2012 Jan;22(1):74-9. doi: 10.1111/j.1552-6569.2010.00554.x. Epub 2010 Dec 1.
Acute basilar artery occlusion is associated with a high risk of stroke, mortality, and poor outcome in survivors. Timely vessel revascularization is critical to improve the clinical outcome in this condition. A subset of patients survives acute occlusion with mild or no disability and some of these individuals develop recurrent ischemic events despite optimal medical therapy. The strategy for management of these patients is unknown.
We described 3 patients with chronic intracranial vertebrobasilar occlusions who presented with recurrent ischemic symptoms and progressive disability. All 3 patients were treated successfully with angioplasty and stenting. One patient experienced headache postprocedure and was found to have subarachnoid hemorrhage, which was self-limiting without need for intervention or result in permanent neurological sequela. All 3 patients have been free of recurrent symptoms for up to 30 months.
Revascularization of chronic vertebrobasilar occlusions is technically feasible. Due to the high-risk nature, it should be reserved as an option only for selected group of patients with recurrent ischemic symptoms and progressive disability despite maximal medical therapy. Further prospective study is helpful to clarify the role of this intervention.
急性基底动脉闭塞与卒中风险高、死亡率高和幸存者预后不良相关。及时的血管再通对于改善这种情况下的临床结局至关重要。一部分患者在急性闭塞后幸存下来，仅有轻度或无残疾，但其中一些患者尽管接受了最佳的药物治疗，仍会发生复发性缺血事件。这些患者的管理策略尚不清楚。
我们描述了 3 例慢性颅内外椎基底动脉闭塞患者，他们出现复发性缺血症状和进行性残疾。所有 3 例患者均通过血管成形术和支架置入术成功治疗。1 例患者术后出现头痛，发现蛛网膜下腔出血，自行缓解，无需介入治疗，也未导致永久性神经后遗症。所有 3 例患者在长达 30 个月的时间内均未出现复发性症状。
慢性椎基底动脉闭塞的血管再通在技术上是可行的。由于风险较高，仅应将其保留为有选择的治疗方案，适用于尽管接受了最大药物治疗但仍有复发性缺血症状和进行性残疾的患者。进一步的前瞻性研究有助于阐明这种干预的作用。
