Liu Mingyuan, Yan Peiguang, Wang Mingxin, Guo Jia, Liu Wei, Wu Ganchun, Wang Lufei, Liu Jingjing, Li Li
Binzhou Medical University, Yantai, China.
Shengli Oilfield Central Hospital, Shandong, China.
Neurosurg Rev. 2024 Dec 14;47(1):901. doi: 10.1007/s10143-024-03153-x.
To investigate the clinical efficacy and safety of microsurgical surgery in patients with proximal vertebral artery stenosis unsuitable for endovascular treatment. A retrospective analysis was conducted on the clinical data of 34 patients with proximal vertebral artery stenosis who underwent microsurgical surgery at the Department of Cerebrovascular Surgery, Shengli Oilfield Central Hospital, Dongying, Shandong, from March 2020 to April 2023. Preoperative imaging confirmation of proximal vertebral artery stenosis or occlusion was obtained using cervical CT angiography (CTA), CT perfusion imaging (CTP), and magnetic resonance angiography (MRA). Postoperative imaging examinations were utilized to evaluate blood flow patency, and clinical symptoms and complications during hospitalization and follow-up were documented. Postoperative imaging examinations in the 34 patients (Males: 79.4%; Mean age: 66.7 ± 9.6 years) revealed patent vertebral and supplying arteries. No new instances of transient ischemic attacks (TIAs) or other cerebrovascular events were observed during hospitalization, and clinical symptoms were improved. The mean follow-up duration was 10 months (range: 6-39 months). One patient died from septic shock due to abdominal infection, and one patient exhibited moderate ipsilateral vertebral artery stenosis on a follow-up CTA at 6 months postoperatively. The Modified Rankin Scale (mRS) scores decreased for 30 patients after surgery compared to preoperative scores, with all postoperative mRS scores being less than 1. The difference between preoperative and postoperative mRS scores was statistically significant (P < 0.01). Six patients experienced temporary postoperative complications, which resolved after active treatment, and one patient developed permanent Horner's syndrome without affecting the quality of life. Microsurgical surgery for patients with proximal vertebral artery stenosis, when endovascular treatment is unsuitable, demonstrates good clinical efficacy and a low incidence of complications, offering a viable surgical treatment option. Further multicenter studies with larger sample sizes will be instrumental in validating its clinical application value.
探讨显微外科手术治疗不适于血管内治疗的椎动脉近端狭窄患者的临床疗效及安全性。回顾性分析2020年3月至2023年4月在山东省东营市胜利油田中心医院脑血管外科接受显微外科手术的34例椎动脉近端狭窄患者的临床资料。术前采用颈部CT血管造影（CTA）、CT灌注成像（CTP）和磁共振血管造影（MRA）对椎动脉近端狭窄或闭塞进行影像学确认。术后采用影像学检查评估血流通畅情况，并记录住院及随访期间的临床症状和并发症。34例患者（男性：79.4%；平均年龄：66.7±9.6岁）术后影像学检查显示椎动脉及供血动脉通畅。住院期间未观察到新的短暂性脑缺血发作（TIA）或其他脑血管事件，临床症状得到改善。平均随访时间为10个月（范围：6 - 39个月）。1例患者因腹部感染死于感染性休克，1例患者术后6个月随访CTA显示同侧椎动脉中度狭窄。与术前相比，30例患者术后改良Rankin量表（mRS）评分降低，术后所有mRS评分均小于1。术前和术后mRS评分差异有统计学意义（P < 0.01）。6例患者术后出现暂时性并发症，经积极治疗后缓解，1例患者出现永久性霍纳综合征，但未影响生活质量。对于不适于血管内治疗的椎动脉近端狭窄患者，显微外科手术显示出良好的临床疗效和较低的并发症发生率，提供了一种可行的手术治疗选择。进一步开展大样本多中心研究将有助于验证其临床应用价值。
