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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2023, Vol. 09 ›› Issue (03) : 170 -174. doi: 10.3877/cma.j.issn.2095-9141.2023.03.008

短篇论著

症状性椎动脉起始部重度狭窄/闭塞行椎动脉内膜切除术的疗效分析
周帅, 王海波, 刘朋飞, 张继红, 马晓艳, 王喆, 张文学, 王金鹏, 王明鑫, 姜丽娜†()   
  1. 262700　山东潍坊，潍坊市人民医院重症医学科
    257000　山东东营，胜利油田中心医院神经外科
    262700　山东潍坊，潍坊市人民医院神经外科
    262700　山东潍坊，潍坊市人民医院脑卒中中心
  • 收稿日期:2023-03-29 出版日期:2023-06-15
  • 通信作者: 姜丽娜

Clinical analysis of severe narrowing/occlusion of symptomatic vertebral artery at the beginning of vertebral artery by endarterectomy

Shuai Zhou, Haibo Wang, Pengfei Liu, Jihong Zhang, Xiaoyan Ma, Zhe Wang, Wenxue Zhang, Jinpeng Wang, Mingxin Wang, Lina Jiang†()   

  1. Department of Critical Care, Weifang People's Hospital, Weifang 262700, China
    Department of Neurosurgery, Shengli Oilfield Central Hospital, Dongying 257000, China
    Department of Neurosurgery, Weifang People's Hospital, Weifang 262700, China
    Stroke Center, Weifang People's Hospital, Weifang 262700, China
  • Received:2023-03-29 Published:2023-06-15
  • Corresponding author: Lina Jiang
  • Supported by:
    Weifang Science and Technology Bureau Project(2020YX058)
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引用本文：

周帅, 王海波, 刘朋飞, 张继红, 马晓艳, 王喆, 张文学, 王金鹏, 王明鑫, 姜丽娜. 症状性椎动脉起始部重度狭窄/闭塞行椎动脉内膜切除术的疗效分析[J]. 中华神经创伤外科电子杂志, 2023, 09(03): 170-174.

Shuai Zhou, Haibo Wang, Pengfei Liu, Jihong Zhang, Xiaoyan Ma, Zhe Wang, Wenxue Zhang, Jinpeng Wang, Mingxin Wang, Lina Jiang. Clinical analysis of severe narrowing/occlusion of symptomatic vertebral artery at the beginning of vertebral artery by endarterectomy[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2023, 09(03): 170-174.

目的

分析症状性椎动脉起始部重度狭窄或闭塞患者行椎动脉内膜切除术的手术疗效。

方法

收集潍坊市人民医院和胜利油田中心医院神经外科、重症医学科、脑卒中中心自2016年10月至2021年12月收治的33例行椎动脉内膜切除术患者的临床资料，所有患者均累及椎动脉起始部的症状性（6个月内发生短暂性脑缺血发作或非致残性卒中）的重度狭窄或闭塞，均经最佳药物治疗（双联抗血小板聚集药物联合他汀类降脂药物及危险因素控制）3个月以上，比较患者术前、术后椎动脉起始部管腔直径、神经功能缺损情况，统计患者术后并发症发生率及血管再狭窄发生率。

结果

33例患者的手术成功率为90.91%（30/33）。术后1周内出现声音嘶哑3例（9.09%）、霍纳综合征2例（6.06%）、乳糜漏1例（3.03%）、出血1例（3.03%）、急性脑梗死1例（3.03%）。33例患者术后起始部管腔直径较术前明显增大，美国国立卫生研究院卒中量表评分较术前明显降低，差异均有统计学意义（P<0.05）。

结论

椎动脉内膜剥脱手术治疗椎动脉起始部重度狭窄或闭塞安全有效。

关键词: 椎动脉狭窄, 椎动脉内膜切除术, 显微技术
Objective

To analyze the curative effect of vertebral artery endarterectomy in patients with severe narrowing or occlusion of symptomatic vertebral artery initiation.

Methods

Clinical data of 33 patients with vertebral artery endarterectomy admitted to the Neurosurgery Department, Intensive Care Medicine Department, and Stroke Center of Weifang People's Hospital and Shengli Oilfield Central Hospital from October 2016 to December 2021 were collected. All patients with severe narrowing or occlusion involving the onset of the vertebral artery (transient ischemic attack or non-disabled stroke within 6 months) were treated with optimal medication (dual antiplatelet aggregation drugs combined with statin lipid-lowering drugs and risk factors) for more than 3 months. The diameter of the initial vertebral artery lumen and neurological deficits between patients before and after surgery were compared, and the incidence of postoperative complications and vascular restenosis were calculated.

Results

The surgical success rate of 33 patients was 90.91% (30/33). Within 1 week after surgery, there were 3 cases of hoarseness (9.09%), 2 cases of Horner's syndrome (6.06%), 1 case of chylous leakage (3.03%), 1 case of bleeding (3.03%), and 1 case of acute cerebral infarction (3.03%). The initial lumen diameter of 33 patients increased significantly after surgery, and the National Institute of Health stroke scale score decreased significantly compared to preoperative, with statistical significance (P<0.05).

Conclusion

The treatment of severe stenosis or occlusion at the beginning of the vertebral artery with vertebral artery endarterectomy is safe and effective.

Key words: Vertebral artery narrowing, Vertebral endarterectomy, Microtechnique
表1 33例患者术前、术后椎动脉起始部管腔直径及NIHSS评分比较（±s）
Tab.1 Comparison of preoperative and postoperative vertebral artery lumen diameter and NIHSS score in 33 patients (Mean±SD)
时间 例数 起始部管腔直径（mm） NIHSS评分（分）
术前 33 0.670±0.420 1.788±0.696
术后 33 5.394±1.991 0.546±0.869
t值   67.146 6.082
P值   <0.001 <0.001
[1]
Moulin S, Leys D. Management of acute cerebral ischaemia[J]. Presse Med, 2016, 45(12 Pt 2): e451-e455. DOI: 10.1016/j.lpm.2016.10.008.
[2]
Lopez AD, Mathers CD, Ezzati M, et al. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data[J]. Lancet, 2006, 367(9524): 1747-1757. DOI: 10.1016/S0140-6736(06)68770-9.
[3]
Liu H, Chu J, Zhang L, et al. Clinical comparison of outcomes of early versus delayed carotid artery stenting for symptomatic cerebral watershed infarction due to stenosis of the proximal internal carotid artery[J]. Biomed Res Int, 2016, 2016: 6241546. DOI: 10.1155/2016/6241546.
[4]
DeBakey ME. Successful carotid endarterectomy for cerebrovascular insufficiency. Nineteen-year follow-up[J]. JAMA, 1975, 233(10): 1083-1085. DOI: 10.1001/jama.1975.03260100053020.
[5]
North American Symptomatic Carotid Endarterectomy Trial Collaborators, Barnett HJM, Taylor DW, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis[J]. N Engl J Med, 1991, 325(7): 445-453. DOI: 10.1056/NEJM199108153250701.
[6]
European Carotid Surgery Trialists' Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST)[J]. Lancet, 1998, 351(9113): 1379-1387. DOI: 10.1016/S0140-6736(97)09292-1.
[7]
Endarterectomy for asymptomatic carotid artery stenosis. Executive committee for the asymptomatic carotid atherosclerosis study[J]. JAMA, 1995, 273(18): 1421-1428.
[8]
Sadato A, Maeda S, Hayakawa M, et al. Endovascular treatment of vertebral artery dissection using stents and coils: its pitfall and technical considerations[J]. Minim Invasive Neurosurg, 2010, 53(5-6): 243-249. DOI: 10.1055/s-0030-1269873.
[9]
Pham MH, Rahme RJ, Arnaout O, et al. Endovascular stenting of extracranial carotid and vertebral artery dissections: a systematic review of the literature[J]. Neurosurgery, 2011, 68(4): 856-866; discussion 866. DOI: 10.1227/NEU.0b013e318209ce03.
[10]
Mazighi M, Labreuche J, Gongora-Rivera F, et al. Autopsy prevalence of proximal extracranial atherosclerosis in patients with fatal stroke[J]. Stroke, 2009, 40(3): 713-718. DOI: 10.1161/STROKEAHA.108.514349.
[11]
Madonis SM, Jenkins JS. Vertebral artery stenosis[J]. Prog Cardiovasc Dis, 2021, 65: 55-59. DOI: 10.1016/j.pcad.2021.02.006.
[12]
Piotin M, Spelle L, Martin JB, et al. Percutaneous transluminal angioplasty and stenting of the proximal vertebral artery for symptomatic stenosis[J]. AJNR Am J Neuroradiol, 2000, 21(4): 727-731.
[13]
Mokin M, Dumont TM, Kass-Hout T, et al. Carotid and vertebral artery disease[J]. Prim Care, 2013, 40(1): 135-151. DOI: 10.1016/j.pop.2012.11.006.
[14]
Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J]. Stroke, 2018, 49(3): e46-e110. DOI: 10.1161/STR.0000000000000158.
[15]
Hidayat H, Medani M, Kavanagh E. Transient iatrogenic Horner's syndrome following carotid endarterectomy[J]. BMJ Case Rep, 2019, 12(2): e228244. DOI: 10.1136/bcr-2018-228244.
[16]
Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2014, 45(7): 2160-2236. DOI: 10.1161/STR.0000000000000024.
[17]
Savitz SI, Caplan LR. Vertebrobasilar disease[J]. N Engl J Med, 2005, 352(25): 2618-2626. DOI: 10.1056/NEJMra041544.
[18]
Berguer R, Flynn LM, Kline RA, et al. Surgical reconstruction of the extracranial vertebral artery: management and outcome[J]. J Vasc Surg, 2000, 31(1 Pt 1): 9-18. DOI: 10.1016/s0741-5214(00)70063-2.
[19]
Brasiliense LB, Albuquerque FC, Spetzler RF, et al. Advances and innovations in revascularization of extracranial vertebral artery[J]. Neurosurgery, 2014, 74 Suppl 1: S102-S115. DOI: 10.1227/NEU.0000000000000218.
[20]
Spetzler RF, Hadley MN, Martin NA, et al. Vertebrobasilar insufficiency. Part 1: Microsurgical treatment of extracranial vertebrobasilar disease[J]. J Neurosurg, 1987, 66(5): 648-661. DOI: 10.3171/jns.1987.66.5.0648.
[21]
Hanel RA, Brasiliense LB, Spetzler RF. Microsurgical revascularization of proximal vertebral artery: a single-center, single-operator analysis[J]. Neurosurgery, 2009, 64(6): 1043-1050; discussion 1051. DOI: 10.1227/01.NEU.0000347099.17437.64.
[22]
Park S, Lee DG, Shim JH, et al. Recanalization of symptomatic vertebral ostial occlusion in patients with acute or subacute stroke[J]. AJNR Am J Neuroradiol, 2014, 35(2): 367-372. DOI: 10.3174/ajnr.A3681.
[23]
Wang C, Zhao P, Sun T, et al. Hybrid recanalization for the treatment of carotid/vertebral in-stent restenosis or occlusion: pilot surgery experiences from one single center[J]. Front Neurol, 2020, 11: 604672. DOI: 10.3389/fneur.2020.604672.
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