Zhao Liming, Xue Bingqian, Guo Gaochao, Wu Ruiyu, Gao Tao, Liu Yang, Sun Yuxue, Hernesniemi Juha, Andrade Barazarte Hugo, Li Tianxiao, Li Chaoyue
Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China.
Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China.
Front Surg. 2023 Feb 13;10:1074438. doi: 10.3389/fsurg.2023.1074438. eCollection 2023.
We aimed to explore the results of OA-PICA-protected bypass grafting in patients with severe stenosis of the vertebral artery combined with PICA.
Three patients with vertebral artery stenosis involving the posterior inferior cerebellar artery, treated by the Department of Neurosurgery of Henan Provincial People's Hospital from January 2018 to December 2021, were retrospectively analyzed. All the patients underwent Occipital Artery-Posterior Inferior Cerebellar Artery (OA-PICA) bypass surgery followed by elective vertebral artery stenting. Intraoperative indocyanine green fluorescence angiography (ICGA) showed patency of the bridge-vessel anastomosis. Postoperatively, the ANSYS software was used to assess the flow pressure changes and vascular shear in combination with the reviewed DSA angiogram. CTA or DSA was reviewed 1-2 years postoperatively, and the prognosis was evaluated by the modified Rankin Scale (mRS) one year postoperatively.
OA-PICA bypass surgery was completed in all patients, with intraoperative ICGA showing a patent bridge anastomosis, followed by stenting of the vertebral artery, and a review of the DSA angiogram. We also employed ANSYS software evaluation of the bypass vessel, which showed stable pressure and low turnover angle, suggesting a low rate of long-term occlusion of the vessel. All patients had no procedure-related complications during their hospitalization, and were followed up for a mean of 24 months postoperatively, with a good prognosis (mRS score of 1) at 1 year postoperatively.
OA-PICA-protected bypass grafting is an effective treatment for patients with severe stenosis of the vertebral artery combined with PICA.
我们旨在探讨枕动脉-小脑后下动脉（OA-PICA）保护下的搭桥术治疗椎动脉严重狭窄合并小脑后下动脉（PICA）病变患者的效果。
回顾性分析2018年1月至2021年12月在河南省人民医院神经外科接受治疗的3例椎动脉狭窄累及小脑后下动脉的患者。所有患者均接受枕动脉-小脑后下动脉（OA-PICA）搭桥手术，随后择期行椎动脉支架置入术。术中吲哚菁绿荧光血管造影（ICGA）显示桥血管吻合通畅。术后，结合复查的数字减影血管造影（DSA）血管造影，使用ANSYS软件评估血流压力变化和血管剪切力。术后1-2年复查CTA或DSA，并在术后1年采用改良Rankin量表（mRS）评估预后。
所有患者均完成了OA-PICA搭桥手术，术中ICGA显示桥血管吻合通畅，随后行椎动脉支架置入术，并复查DSA血管造影。我们还使用ANSYS软件对搭桥血管进行评估，结果显示压力稳定且周转角度低，提示血管长期闭塞率低。所有患者住院期间均无手术相关并发症，术后平均随访了24个月，术后1年预后良好（mRS评分为1）。
OA-PICA保护下的搭桥术是治疗椎动脉严重狭窄合并PICA病变患者的有效方法。
