医学
外科
血管成形术
再狭窄
改良兰金量表
闭塞
基底动脉
狭窄
血管造影
气球
支架
血运重建
椎基底动脉供血不足
放射科
椎动脉
缺血
内科学
心肌梗塞
缺血性中风
作者
Shervin R. Dashti,Min S. Park,Michael Stiefel,Cameron G. McDougall,Felipe C. Albuquerque
出处
期刊:Neurosurgery
[Oxford University Press]
日期:2010-03-17
卷期号:66 (4): 825-832
被引量:36
标识
DOI:10.1227/01.neu.0000367611.78898.a3
摘要
INTRODUCTION Occlusion of the basilar artery (BA) has a poor prognosis. We evaluated technical considerations and complications associated with reopening subacute to chronically occluded BAs. METHODS Duration of BA occlusion before revascularization, symptoms and medical management before treatment, and postprocedural antiplatelet regimen and anticoagulation protocols of 9 patients were analyzed. All patients underwent endovascular low-volume balloon angioplasty followed by Wingspan stenting. RESULTS The median time between onset of symptoms and treatment was 5 days (range, 2 days to 3.5 years). The median time between documentation of BA occlusion by cerebral angiography or computed tomography angiography and treatment was 3 days (range, 1 day to 8 months). Recanalization was successful in 8 of the 9 patients. Immediately after the procedure, 4 patients were stable, 3 patients improved, and 2 patients were worse. Four patients had periprocedural complications. Four of the 9 patients died, 2 from periprocedural complications. The mean clinical duration of follow-up was 11 months. At latest follow-up, the modified Rankin Scale scores for the 5 surviving patients were 0, 0, 2, 2, and 3, respectively. During the follow-up period, 4 patients improved, 1 patient remained stable, and 1 patient died. The mean angiographic follow-up was 8.6 months. Two patients developed significant in-stent stenosis during this period. CONCLUSION With current endovascular techniques, recanalization of chronically occluded BAs is feasible. The procedure carries substantial risks and should be reserved for patients with medically refractory symptoms. Careful postprocedural medical management and radiographic follow-up are warranted to prevent in-stent restenosis.
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