Martín-González R
Sección de Neurología, Hospital Universitario de San Juan, Alicante, España.
Rev Neurol. 1998 Jan;26(149):118-21.
To analyze the mechanisms involved in the appearance of ischemia in vertebro-basilar territory, especially those of embolic or thrombotic characteristics.
The mechanism of vertebro-basilar ischemia had not been adequately studied until a few years ago. This had led to the belief that most were due to a haemodynamic mechanism. However, in recent years studies of large numbers of patients, in whom cardiological and neurovascular evaluation had been systematically carried out, has shown that this is not so. In general, the commonest mechanism is embolism, both of arterial and of cardiac origin. Local thrombosis and a haemodynamic mechanism are less common. The arterial lesions most often associated with intra-arterial embolism have their origins in the intracranial segment of the vertebral artery. The most frequent sites of blockage by emboli are the distal segments of the basilar artery, the superior cerebellar artery, the posterior cerebral artery and the intracranial region of the vertebral artery-posteriorinferior cerebellar artery.
The mechanism of vertebro-basilar ischemia is not homogeneous and can not be taken for granted in any patient in particular. For this reason it is necessary to carry out a full clinical study of patients with these symptoms, similar to that done for patients with carotid ischemia. This permits not only individualized, correct treatment of each patient but also a more complete knowledge of the mechanisms of ischemia in this territory.
分析椎基底动脉供血区缺血出现的机制，尤其是具有栓塞或血栓形成特征的机制。
直到几年前，椎基底动脉缺血的机制都尚未得到充分研究。这导致人们认为大多数情况是由于血流动力学机制。然而，近年来对大量患者进行系统的心脏和神经血管评估的研究表明并非如此。一般来说，最常见的机制是栓塞，包括动脉源性和心脏源性。局部血栓形成和血流动力学机制则较少见。与动脉内栓塞最常相关的动脉病变起源于椎动脉的颅内段。栓子阻塞最常见的部位是基底动脉远端、小脑上动脉、大脑后动脉以及椎动脉 - 小脑后下动脉的颅内区域。
椎基底动脉缺血的机制并非单一，不能想当然地认为某一特定患者就是某种机制。因此，有必要对有这些症状的患者进行全面的临床研究，就如同对颈动脉缺血患者所做的那样。这不仅能对每位患者进行个体化、正确的治疗，还能更全面地了解该供血区缺血的机制。
