Kondo Ryushi, Ishihara Shoichiro, Uemiya Nahoko, Kakehi Yoshiaki, Nakadate Masashi, Singu Takaomi, Tsuzuki Nobusuke, Tokushige Kazuo
Department of Neuroendovascular Therapy, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan.
Department of Neurosurgery, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan.
NMC Case Rep J. 2021 Dec 22;8(1):817-825. doi: 10.2176/nmccrj.cr.2021-0268. eCollection 2021.
Vertebrobasilar artery dissection is an uncommon cause of acute ischaemic stroke (AIS). Optimal endovascular management has not been established. This study aimed to share our experience with endovascular reperfusion therapy for vertebrobasilar artery occlusion due to vertebral artery dissection (VAD). We retrospectively reviewed 134 consecutive patients with AIS who received urgent endovascular reperfusion therapy between November 2017 and November 2019. Three patients diagnosed with VAD were investigated. The evaluation included mechanisms of vertebrobasilar artery occlusion due to VAD, variations in endovascular procedures, and functional outcomes. Dissections at the V3, V4 and extension of V3 to V4 segments were seen in one patient each. The mechanism of AIS was different in each patient: occlusion of the distal non-dissected artery due to an embolus from the dissection site (), haemodynamic collapse of the entire vertebrobasilar artery system due to the arterial dissection itself (), or coexistence of and (). The endovascular reperfusion therapy was performed corresponding to the abovementioned mechanisms: mechanical thrombectomy for , stenting for , and a combination of thrombectomy and stenting for . In all three patients, effective recanalization and functional independence (modified Rankin Scale scores of 0-2 at 90 days after the onset) were achieved. Endovascular treatment corresponding to the individual mechanism of AIS may improve patient outcomes.
椎基底动脉夹层是急性缺血性卒中（AIS）的一种罕见病因。最佳的血管内治疗方案尚未确立。本研究旨在分享我们对因椎动脉夹层（VAD）导致的椎基底动脉闭塞进行血管内再灌注治疗的经验。我们回顾性分析了2017年11月至2019年11月期间连续接受紧急血管内再灌注治疗的134例AIS患者。对3例诊断为VAD的患者进行了研究。评估内容包括VAD导致椎基底动脉闭塞的机制、血管内手术的差异以及功能结局。分别在1例患者中观察到V3、V4段以及V3段至V4段的夹层。每位患者的AIS机制各不相同：因夹层部位的栓子导致远端未夹层动脉闭塞（），因动脉夹层本身导致整个椎基底动脉系统血流动力学崩溃（），或两者并存（）。针对上述机制进行了血管内再灌注治疗：对采用机械取栓，对采用支架置入，对采用取栓和支架置入联合治疗。所有3例患者均实现了有效的再通和功能独立（发病后90天改良Rankin量表评分为0 - 2分）。针对AIS个体机制的血管内治疗可能会改善患者预后。
