症状性椎动脉颅内段狭窄的临床分析
发布时间：2019-03-17 18:48
【摘要】：目的： 探讨症状性椎动脉颅内段(ICVA)狭窄的临床特点、影像学特征、治疗方法及预后。 方法： 2014年1月至2015年3月在我院神经内科住院治疗的10例症状性ICVA狭窄患者,分析其相关的临床资料及治疗经过,并进行随访观察。所有患者住院期间均完成头颅磁共振成像(MRI)、数字剪影血管造影(DSA)和经颅多普勒超声(TCD)检查。根据脑血管检查结果,对10例患者ICVA病变的特点进行分析,并探讨ICVA病变与临床表现、治疗、预后的关系。 结果： 10例患者中,男性8例,女性2例,平均年龄(60±9.24)岁,6例诊断为后循环短暂性脑缺血发作(TIA),4例为后循环缺血性卒中；高血压8例,糖尿病4例,高同型半胱氨酸血症3例,血脂障碍2例,吸烟4例,临床症状主要为头晕／眩晕、行走不稳、言语不利和肢体麻木无力。10例患者中单侧ICVA狭窄6例,双侧ICVA均受累4例；6例患者同时合并颈部或其他颅内动脉50%的狭窄,包括椎动脉起始部、大脑中动脉、颈内动脉以及基底动脉；7例患者合并椎动脉优势。ICVA狭窄／闭塞的好发部位依次为远段(8/14)、近段(5/14)和中段(1/14)。4例脑梗死的患者中有3例为双侧ICVA病变,6例TIA的患者中有5例为单侧ICVA狭窄。在单侧ICVA狭窄的6例患者中,患侧椎动脉血流速度减慢,收缩期血流速度均小于40cm/s,收缩期血流速度和平均血流速度显著低于健侧(P0.05),血管搏动指数显著高于健侧(P0.01)。所有患者均在抗血小板治疗的基础上积极控制脑血管病危险因素,5例患者接受血管内支架治疗,操作均获得成功且无围术期并发症发生。对10例患者进行了平均(6.80±3.68)个月的随访,除1例脑梗死患者遗留中度残疾外,余患者预后良好。所有患者均无新发卒中事件。 结论： 症状性ICVA狭窄患者的临床症状缺乏特异性,常合并椎动脉优势和其他部位的狭窄与闭塞。动脉粥样硬化引起的严重狭窄常见于ICVA的远段,双侧ICVA病变在脑梗死患者中更常见。TCD提示ICVA狭窄近端的血流呈低流速高搏动样改变。大部分症状性ICVA狭窄患者的短期预后良好。
[Abstract]:Objective: to investigate the clinical features, imaging features, treatment and prognosis of symptomatic intracranial (ICVA) stenosis of vertebral artery. Methods: from January 2014 to March 2015, 10 patients with symptomatic ICVA stenosis were treated in our department of neurology. The clinical data and treatment process were analyzed and followed up. All patients underwent magnetic resonance imaging (MRI),) digital silhouette angiography (DSA) and transcranial Doppler ultrasound (TCD) during hospitalization. According to the results of cerebral vascular examination, the characteristics of ICVA lesions in 10 patients were analyzed, and the relationship between ICVA lesions and clinical manifestations, treatment and prognosis was discussed. Results: of the 10 patients, 8 were male and 2 were female, the mean age was (60 卤9.24) years, 6 patients were diagnosed as transient ischemic attack of posterior circulation (TIA), 4 patients were diagnosed as posterior circulation ischemic stroke. There were 8 cases of hypertension, 4 cases of diabetes, 3 cases of hyperhomocysteinemia, 2 cases of dyslipidemia and 4 cases of smoking. The main clinical symptoms were dizziness / vertigo and unstable walking. In 10 cases, unilateral ICVA stenosis was found in 6 cases, bilateral ICVA was involved in 4 cases; Six patients had 50% stenosis of the neck or other intracranial arteries, including the origin of the vertebral artery, the middle cerebral artery, the internal carotid artery and the basilar artery. The main sites of stenosis / occlusion were distal segment (8 / 14), proximal segment (5 / 14) and middle segment (1 / 14). Of the 4 patients with cerebral infarction, 3 were bilateral ICVA lesions, and 3 of 4 patients with cerebral infarction were found to be bilateral lesions, and the most common sites of stenosis / occlusion were distal (8 / 14), proximal (5 / 14) and middle (1 / 14). Of the 6 patients with TIA, 5 had unilateral ICVA stenosis. In 6 patients with unilateral ICVA stenosis, the blood flow velocity of vertebral artery slowed down, systolic blood flow velocity was less than 40 cm / s, systolic velocity and mean blood flow velocity were significantly lower in the affected side than in the healthy side (P0.05). The pulsatile index of blood vessel was significantly higher than that of healthy side (P0.01). All patients actively controlled the risk factors of cerebrovascular disease on the basis of antiplatelet therapy, and 5 patients received endovascular stent therapy. All patients were successful and had no perioperative complications. Ten patients were followed up for an average of (6.80 卤3.68) months. Except for one patient with cerebral infarction, the prognosis of the remaining patients was good except for one patient with moderate disability. There were no new stroke events in all patients. Conclusion: the clinical symptoms of symptomatic ICVA stenosis are not specific and often associated with vertebral artery dominance and stenosis and occlusion in other parts. Severe stenosis caused by atherosclerosis was common in the distal segment of ICVA, and bilateral ICVA lesions were more common in patients with cerebral infarction. It was suggested that the blood flow at the proximal end of ICVA stenosis showed a low flow rate and a high pulsation-like change. Most patients with symptomatic ICVA stenosis had a good short-term prognosis.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R743.3
本文编号：2442591
[Abstract]:Objective: to investigate the clinical features, imaging features, treatment and prognosis of symptomatic intracranial (ICVA) stenosis of vertebral artery. Methods: from January 2014 to March 2015, 10 patients with symptomatic ICVA stenosis were treated in our department of neurology. The clinical data and treatment process were analyzed and followed up. All patients underwent magnetic resonance imaging (MRI),) digital silhouette angiography (DSA) and transcranial Doppler ultrasound (TCD) during hospitalization. According to the results of cerebral vascular examination, the characteristics of ICVA lesions in 10 patients were analyzed, and the relationship between ICVA lesions and clinical manifestations, treatment and prognosis was discussed. Results: of the 10 patients, 8 were male and 2 were female, the mean age was (60 卤9.24) years, 6 patients were diagnosed as transient ischemic attack of posterior circulation (TIA), 4 patients were diagnosed as posterior circulation ischemic stroke. There were 8 cases of hypertension, 4 cases of diabetes, 3 cases of hyperhomocysteinemia, 2 cases of dyslipidemia and 4 cases of smoking. The main clinical symptoms were dizziness / vertigo and unstable walking. In 10 cases, unilateral ICVA stenosis was found in 6 cases, bilateral ICVA was involved in 4 cases; Six patients had 50% stenosis of the neck or other intracranial arteries, including the origin of the vertebral artery, the middle cerebral artery, the internal carotid artery and the basilar artery. The main sites of stenosis / occlusion were distal segment (8 / 14), proximal segment (5 / 14) and middle segment (1 / 14). Of the 4 patients with cerebral infarction, 3 were bilateral ICVA lesions, and 3 of 4 patients with cerebral infarction were found to be bilateral lesions, and the most common sites of stenosis / occlusion were distal (8 / 14), proximal (5 / 14) and middle (1 / 14). Of the 6 patients with TIA, 5 had unilateral ICVA stenosis. In 6 patients with unilateral ICVA stenosis, the blood flow velocity of vertebral artery slowed down, systolic blood flow velocity was less than 40 cm / s, systolic velocity and mean blood flow velocity were significantly lower in the affected side than in the healthy side (P0.05). The pulsatile index of blood vessel was significantly higher than that of healthy side (P0.01). All patients actively controlled the risk factors of cerebrovascular disease on the basis of antiplatelet therapy, and 5 patients received endovascular stent therapy. All patients were successful and had no perioperative complications. Ten patients were followed up for an average of (6.80 卤3.68) months. Except for one patient with cerebral infarction, the prognosis of the remaining patients was good except for one patient with moderate disability. There were no new stroke events in all patients. Conclusion: the clinical symptoms of symptomatic ICVA stenosis are not specific and often associated with vertebral artery dominance and stenosis and occlusion in other parts. Severe stenosis caused by atherosclerosis was common in the distal segment of ICVA, and bilateral ICVA lesions were more common in patients with cerebral infarction. It was suggested that the blood flow at the proximal end of ICVA stenosis showed a low flow rate and a high pulsation-like change. Most patients with symptomatic ICVA stenosis had a good short-term prognosis.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R743.3
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相关期刊论文 前2条
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2 王斌;王亚冰;李慎茂;朱凤水;吉训明;焦力群;缪中荣;凌锋;;动脉溶栓联合血管成形术治疗急性缺血性卒中的单中心研究[J];中国脑血管病杂志;2011年02期
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