Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada.
World Neurosurg. 2019 Oct;130:e722-e725. doi: 10.1016/j.wneu.2019.06.203. Epub 2019 Jul 5.
Posterior circulation strokes account for over one quarter of all ischemic strokes. The frequency of vertebral artery origin stenosis (VAOS) in patients with vertebrobasilar insufficiency (VBI) has been estimated to be as high 26%-32%, and VAOS is the direct cause of posterior circulation strokes in 9% of patients. This association could have a significant genetic component. This study examines the feasibility of the internal thoracic artery (ITA) as a donor vessel for revascularization in patients with VAOS.
Ten sides from 5 fresh-frozen white cadaveric necks derived from 3 women and 2 men were used in this study. The mean age of the cadavers at death was 77.2 years (range, 68-88 years). The subclavian artery, vertebral artery, and ITA were dissected. The length and diameter (proximal and distal) of the V1 segment and the length and diameter of the ITA were recorded. Finally, the ITA was transposed to the V1 segment of the vertebral artery (VA1).
The mean length of the VA1 and its diameter at the proximal and distal parts were 35.51 and 3.69 mm, respectively. The mean length and diameter of the ITA were 26.53 and 3.27 mm, respectively. Rerouting the ITA to the VA1 was feasible without tension on all sides.
This study indicates that the ITA is anatomically and hemodynamically an excellent option for bypass surgery in a VAOS scenario. We present convincing and reproducible data to aid neurosurgeons in choosing the procedure best suited to their patients.
后循环卒中占所有缺血性卒中的四分之一以上。椎基底动脉供血不足（VBI）患者椎动脉起源狭窄（VAOS）的频率估计高达 26%-32%，VAOS 是后循环卒中的直接原因在 9%的患者中。这种关联可能具有重要的遗传成分。本研究探讨了胸廓内动脉（ITA）作为 VAOS 患者血运重建供血管的可行性。
本研究使用了 5 个来自 3 名女性和 2 名男性的新鲜冷冻白尸头的 10 侧。尸体死亡时的平均年龄为 77.2 岁（范围，68-88 岁）。解剖锁骨下动脉、椎动脉和 ITA。记录 V1 段的长度和直径（近端和远端）以及 ITA 的长度和直径。最后，将 ITA 转位至椎动脉的 V1 段（VA1）。
VA1 的平均长度及其近端和远端的直径分别为 35.51mm 和 3.69mm。ITA 的平均长度和直径分别为 26.53mm 和 3.27mm。在所有侧面，将 ITA 重新路由至 VA1 而没有张力是可行的。
本研究表明，ITA 在解剖学和血液动力学上是 VAOS 情况下旁路手术的极佳选择。我们提供了令人信服且可重复的数据，以帮助神经外科医生选择最适合其患者的手术。
