Ikeda Hiroyuki, Imamura Hirotoshi, Mineharu Yohei, Tani Shoichi, Adachi Hidemitsu, Sakai Chiaki, Ishikawa Tatsuya, Asai Katsunori, Sakai Nobuyuki
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
Interv Neuroradiol. 2016 Feb;22(1):67-75. doi: 10.1177/1591019915609127. Epub 2015 Oct 13.
Medullary infarction is an important complication of internal trapping for vertebral artery dissection. This study investigated risk factors for medullary infarction following internal trapping of ruptured vertebral artery dissection.
We retrospectively studied 26 patients with ruptured vertebral artery dissection who underwent endovascular treatment and postoperative magnetic resonance imaging between April 2001 and March 2013. Clinical and radiological findings were analyzed to identify factors associated with postoperative medullary infarction.
Ten of the 26 patients (38%) showed postoperative lateral medullary infarction on magnetic resonance imaging. Multivariate logistic regression analysis revealed that medullary infarction was independently associated with poor clinical outcome (odds ratio (OR) 17.01; 95% confidence interval (CI) 1.68-436.81; p=0.032). Univariate analysis identified vertebral artery dissection on the right side and longer length of the entire trapped area as risk factors for postoperative medullary infarction. When the trapped area was divided into three segments (dilated, distal, and proximal segments), proximal segment length, but not dilated segment length, was significantly associated with medullary infarction (OR 1.55 for a 1-mm increase in proximal segment length; 95% CI 1.15-2.63; p=0.027). Receiver operating characteristic analysis showed that proximal segment length offered a good predictor of the risk of postoperative medullary infarction, with a cut-off value of 5.8 mm (sensitivity 100%; specificity 82.3%).
Longer length of the trapped area, specifically the segment proximal to the dilated portion, is associated with a higher incidence of medullary infarction following internal trapping, indicating that this complication may be avoidable.
延髓梗死是椎动脉夹层内圈套术的一种重要并发症。本研究调查了破裂性椎动脉夹层内圈套术后延髓梗死的危险因素。
我们回顾性研究了2001年4月至2013年3月期间接受血管内治疗及术后磁共振成像的26例破裂性椎动脉夹层患者。分析临床和影像学结果以确定与术后延髓梗死相关的因素。
26例患者中有10例（38%）在磁共振成像上显示术后延髓外侧梗死。多因素逻辑回归分析显示，延髓梗死与临床预后不良独立相关（比值比（OR）17.01；95%置信区间（CI）1.68 - 436.81；p = 0.032）。单因素分析确定右侧椎动脉夹层及整个圈套区域较长为术后延髓梗死的危险因素。当将圈套区域分为三个节段（扩张段、远端段和近端段）时，近端段长度而非扩张段长度与延髓梗死显著相关（近端段长度每增加1 mm，OR为1.55；95% CI 1.15 - 2.63；p = 0.027）。受试者工作特征分析表明，近端段长度对术后延髓梗死风险具有良好的预测价值，截断值为5.8 mm（敏感性100%；特异性82.3%）。
圈套区域较长，特别是扩张部分近端的节段，与内圈套术后延髓梗死的较高发生率相关，表明这种并发症可能是可避免的。
