Allen G S, Cohen R J, Preziosi T J
Neurosurgery. 1981 Jan;8(1):56-9. doi: 10.1227/00006123-198101000-00011.
Two patients who had typical vertebrobasilar transient ischemic attacks (TIAs) that were refractory to anticoagulation with dicumarol and to antiplatelet therapy with aspirin and/or dipyridamole are described. Angiography revealed in both patients a stenotic atherosclerotic plaque of the intracranial vertebral artery between the posterior and anterior inferior cerebellar arteries. At operation, the first patient had an atherosclerotic plaque extending into the basilar artery, and no endarterectomy was attempted. The second patient had a 1-cm localized plaque that was removed successfully from the vertebral artery. Neither patient sustained a neurological deficit as a result of the operation. The patient whose plaque was not removed at operation continues to have vertebrobasilar TIAs and suffered a brain stroke 2 weeks after operation. The patient whose plaque was removed at operation continues to be free of TIAs 8 months later, and angiography performed 3 months after operation showed a widely patent vertebral artery. A portion of the intracranial vertebral artery has now been shown to be accessible to endarterectomy using the operating microscope. Angiography is helpful in determining this accessibility preoperatively.
本文描述了两名患有典型椎基底动脉短暂性脑缺血发作（TIAs）的患者，他们对抗凝药物双香豆素以及阿司匹林和/或双嘧达莫的抗血小板治疗均无效。血管造影显示，两名患者的小脑后下动脉和小脑前下动脉之间的颅内椎动脉均存在狭窄性动脉粥样硬化斑块。手术时，第一名患者的动脉粥样硬化斑块延伸至基底动脉，未尝试进行内膜切除术。第二名患者有一个1厘米的局限性斑块，成功地从椎动脉中切除。两名患者术后均未出现神经功能缺损。手术中未切除斑块的患者继续出现椎基底动脉TIAs，并在术后2周发生脑卒。手术中切除斑块的患者在8个月后仍未出现TIAs，术后3个月进行的血管造影显示椎动脉通畅。现已证明，使用手术显微镜可对部分颅内椎动脉进行内膜切除术。血管造影有助于术前确定这种可及性。
