Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
AJNR Am J Neuroradiol. 2013 Mar;34(3):583-8. doi: 10.3174/ajnr.A3248. Epub 2012 Aug 16.
VBD can trigger various clinical symptoms, especially ischemic stroke in the posterior circulation, but there is no effective treatment for their prevention. We aimed to validate the feasibility of coil-assisted stent reconstruction in the vascular lumen for the treatment of VBD and to evaluate its long-term effectiveness in preventing ischemic events.
Clinical and imaging data of 9 patients with unruptured VBD were reviewed retrospectively. Depending on the length and diameter of the diseased target vessel, multiple LEO and/or Solitaire stents were implanted, assisted by coils.
Stent reconstruction in the vascular lumen was successful in all patients. Procedure-related complications occurred in 1 patient who developed brain stem and cerebellar infarction 8 days after endovascular treatment and died in 4 months. Coil embolization of the nondominant side of the vertebral artery was performed 1 month after the operation in 1 patient who developed partial brain stem and cerebellar infarction leading to hemiplegia. The mean follow-up time of the 8 surviving patients was 20.75 ± 6.90 months. Of the 4 patients with dolichoectasia in the anterior circulation, 2 experienced ischemic events in the anterior circulation. Another patient had sudden death at home 26 months after the operation. The conditions of the remaining 5 patients were stable without deterioration, and in 4, DSA/CTA/MRA suggested improved morphology of the vertebral artery compared with that before the operation.
Endovascular reconstruction with coil-assisted stent placement or stent placement alone in the vascular lumen for the treatment of VBD is technically feasible and can prevent ischemic events in the territory of stented vessels compared with the natural course, though further studies in larger samples are needed.
血管壁发育不良（VBD）可引发多种临床症状，尤其是后循环缺血性卒中，但目前尚无有效的预防方法。本研究旨在验证血管腔内线圈辅助支架重建治疗 VBD 的可行性，并评估其预防缺血性事件的长期效果。
回顾性分析 9 例未破裂 VBD 患者的临床和影像学资料。根据病变靶血管的长度和直径，采用多个 LEO 和/或 Solitaire 支架，并辅助使用线圈进行血管腔内支架重建。
所有患者均成功完成了血管腔内支架重建。1 例患者在血管内治疗 8 天后发生脑干和小脑梗死，4 个月后死亡，该患者发生了与手术相关的并发症。1 例患者在手术后 1 个月出现椎动脉非优势侧线圈栓塞，导致部分脑干和小脑梗死，出现偏瘫。8 例存活患者的平均随访时间为 20.75±6.90 个月。在前循环迂曲扩张的 4 例患者中，2 例发生前循环缺血性事件。另 1 例患者在术后 26 个月在家中猝死。其余 5 例患者的病情稳定，无恶化，4 例患者的椎动脉形态学较术前改善，DSA/CTA/MRA 提示。
血管腔内线圈辅助支架置入或单纯支架置入治疗 VBD 技术上是可行的，与自然病程相比，可预防支架血管供血区的缺血性事件，但需要进一步扩大样本量进行研究。
