Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan.
Neuroradiology. 2013 Feb;55(2):201-6. doi: 10.1007/s00234-012-1114-9. Epub 2012 Nov 14.
Previous reports have suggested that endovascular parent artery occlusion is an effective and safe procedure for the treatment of vertebral artery dissection (VAD). However, the results of long-term outcomes are still unclear. This study reviewed the clinical and imaging outcomes of patients with VAD treated by endovascular internal trapping.
A total of 73 patients were treated for VAD by endovascular internal trapping between March 1998 and March 2011. Patients were regularly followed up by magnetic resonance imaging, magnetic resonance angiography, and clinical examinations. Clinical outcomes were evaluated using the modified Rankin Scale.
Forty-five patients had ruptured VADs, and 28 had unruptured VADs. Clinical follow-up of at least 6 months data was obtained for 61 patients (83.6 %). The follow-up period ranged from 6 to 145 months (mean ± SD, 55.6 ± 8.9 months). Two patients with ruptured VADs had recurrence (2.74 %). Cranial nerve paresis (CNP) was observed in six patients (8.21 %), spinal cord infarction in two patients (2.74 %), and a perforating artery ischemia was diagnosed in seven patients (9.59 %); all patients with CNP and five of the patients with partial Wallenberg syndrome experienced only temporary symptoms; two of the patients with partial Wallenberg syndrome had permanent neurological deficits. Despite their symptoms, most patients were in good general condition, as shown by their clinical scores.
The results of this study have proven that endovascular internal trapping is a stable and durable treatment for closure of VADs. Recanalization is rather rare and occurred only in ruptured cases, both within 3 months after initial treatment without rupture. CNPs were observed in 8.21 %, perforating ischemia in 9.59 %, and spinal cord infarction in 2.74 %. The former two are temporary, while the last can be a factor that affects the modified Rankin Scale. Patients rated their quality of life as good, as corroborated by their posttreatment clinical score. Endovascular internal trapping for VAD is a therapy with a satisfactory long-term outcome.
先前的报告表明，血管内母动脉闭塞是治疗椎动脉夹层（VAD）的有效且安全的方法。然而，长期结果仍不清楚。本研究回顾了通过血管内内置捕获治疗的 VAD 患者的临床和影像学结果。
1998 年 3 月至 2011 年 3 月期间，共有 73 例 VAD 患者接受血管内内置捕获治疗。患者定期接受磁共振成像、磁共振血管造影和临床检查。使用改良 Rankin 量表评估临床结果。
45 例患者为破裂性 VAD，28 例患者为未破裂性 VAD。61 例患者（83.6%）获得了至少 6 个月的临床随访数据。随访时间为 6 至 145 个月（平均±标准差，55.6±8.9 个月）。2 例破裂性 VAD 患者复发（2.74%）。6 例患者出现颅神经麻痹（CNP）（8.21%），2 例患者出现脊髓梗死（2.74%），7 例患者诊断为穿支动脉缺血（9.59%）；所有 CNP 患者和 5 例部分延髓外侧综合征患者仅出现短暂症状；2 例部分延髓外侧综合征患者存在永久性神经功能缺损。尽管有症状，但大多数患者的一般状况良好，这反映在他们的临床评分中。
本研究结果证明，血管内内置捕获是治疗 VAD 的一种稳定且持久的方法。再通相当罕见，仅在破裂性病例中发生，均在初次治疗后 3 个月内无破裂。CNP 发生率为 8.21%，穿支动脉缺血发生率为 9.59%，脊髓梗死发生率为 2.74%。前两者为暂时性，而后者则可能是影响改良 Rankin 量表的因素。患者的生活质量自评良好，这与他们治疗后的临床评分相符。VAD 的血管内内置捕获治疗具有满意的长期结果。
