Yoshida S, Yonekawa Y, Kouno T, Sadato A
National Cardiovascular Center, Department of Neurosurgery.
No Shinkei Geka. 1990 Mar;18(3):307-11.
A case of basilar artery occlusion after STA-SCA bypass surgery is reported. The patient was a 56 year old male and presented a TIA of vertigo and speech disturbance. The preoperative angiogram revealed severe stenosis of the basilar artery in its midportion between the bifurcation of AICA and that of SCA. After surgery, the patient's clinical course was uneventful, but the angiogram showed that the previous stenotic segment of the basilar artery had been occluded and the distal portion of the basilar artery and its branches were perfused through the widely-patent STA-SCA bypass. About 6 months after the operation, the patient developed a pontine infarction in the right paramedian region, which was confirmed on MRI. The angiogram revealed that the occlusion of the basilar artery extended further proximally to a point just distal to the bifurcation of AICA. So it was suspected that the perforating branches of the basilar artery to the pons were occluded with the extension of the thrombosis of the basilar artery. The hemodynamic changes associated with the EC-IC bypass was thought to be responsible for the occlusion of the previous stenotic lesion.
报告了一例颞浅动脉-小脑上动脉搭桥手术后基底动脉闭塞的病例。患者为一名56岁男性，出现眩晕和言语障碍的短暂性脑缺血发作。术前血管造影显示基底动脉在小脑前下动脉（AICA）分叉与小脑上动脉（SCA）分叉之间的中段严重狭窄。手术后，患者的临床过程平稳，但血管造影显示基底动脉先前的狭窄段已闭塞，基底动脉远端及其分支通过通畅的颞浅动脉-小脑上动脉搭桥获得灌注。术后约6个月，患者在右侧旁正中区域发生脑桥梗死，磁共振成像（MRI）证实了这一点。血管造影显示基底动脉闭塞进一步向近端延伸至小脑前下动脉分叉远端的一点。因此怀疑随着基底动脉血栓形成的扩展，基底动脉至脑桥的穿支被闭塞。认为与颅外-颅内搭桥相关的血流动力学变化是导致先前狭窄病变闭塞的原因。
