Lu Tony, Chinnadurai Ponraj, Anaya-Ayala Javier E, Diaz Orlando M
1 Division of Vascular and Endovascular Surgery, Houston Methodist Hospital, USA.
2 Angiography Division, Siemens Medical Solutions USA Inc., USA.
Interv Neuroradiol. 2017 Feb;23(1):73-78. doi: 10.1177/1591019916673221. Epub 2016 Oct 27.
We herein present a rare case of bilateral positional vertebrobasilar insufficiency secondary to mechanical obstruction of the V2 segment of the vertebral artery in a 71-year-old patient presenting with vertigo, occipital headache, tremors and respiratory irregularities. Two-dimensional digital subtraction angiography is the traditional diagnostic imaging standard but does not capture any peri-vascular bony or soft tissue abnormalities that are important to understand the three-dimensional pathophysiology. Intra-procedural cone-beam computed tomography (CT) is an increasingly used diagnostic adjunct, available in most modern angiographic suites that allows for the three-dimensional visualization of the vasculature as well as CT-like soft tissue visualization of its surrounding anatomy. In this case, we report the additional value of three-dimensional reconstructed cone-beam CT angiographic imaging that led to the successful diagnosis of bilateral positional vertebrobasilar disease. The patient subsequently received C4-C6 cervical decompression and fusion and remains symptom free at 1 year follow-up.
我们在此报告一例罕见病例，一名71岁患者因椎动脉V2段机械性梗阻继发双侧体位性椎基底动脉供血不足，表现为眩晕、枕部头痛、震颤和呼吸不规则。二维数字减影血管造影是传统的诊断成像标准，但无法捕捉任何对理解三维病理生理学很重要的血管周围骨骼或软组织异常。术中锥形束计算机断层扫描（CT）是一种越来越常用的诊断辅助手段，在大多数现代血管造影设备中都有，它可以对血管系统进行三维可视化，并对其周围解剖结构进行类似CT的软组织可视化。在本病例中，我们报告了三维重建锥形束CT血管造影成像的额外价值，它成功诊断了双侧体位性椎基底动脉疾病。该患者随后接受了C4-C6颈椎减压融合术，在1年的随访中仍无症状。
