Appropriate Flow Reduction for Unilateral Ruptured Vertebral Artery Dissection by Proximal Clipping to Prevent Rebleeding and Medullary Infarction.
Appropriate Flow Reduction for Unilateral Ruptured Vertebral Artery Dissection by Proximal Clipping to Prevent Rebleeding and Medullary Infarction.
复制标题
通过近端夹闭适当减少单侧破裂椎动脉夹层的流量，以防止再出血和髓样梗死。
DOI：
10.1016/j.wneu.2019.06.174
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发表时间：
2019
影响因子：
2
通讯作者：
Yoshiaki Takamura
中科院分区：
文献类型：
--
作者：
Yasushi Motoyama;Yoshiaki Takamura
研究背景：椎动脉夹层破裂（VAD）治疗后偶而发生髓性梗死（MI）。本研究的目的是验证是否流量减少破裂单侧VAD近端夹防止再出血和MI相比trapping.MethodsThirteen 1例谁接受直接手术或血管内手术单侧破裂VAD和术后磁共振成像（MRI），包括9例治疗与陷阱和22例治疗与近端夹，被招募。对于小脑后下动脉（PICA）受累型VAD，根据需要增加枕动脉至PICA吻合以隔离破裂点。比较两组再出血率及MRI显示MI的发生率。然而，5例患者术后MRI显示MI（16.1%，κ = 0.903）。在接受陷获治疗的9例患者中，5例患者在治疗后MRI上观察到MI（55.6%）。而近端夹闭组22例中无1例发生心肌梗死（P< 0.01）。结论近端夹闭术对破裂的单侧VAD进行适当的减流量，可有效防止再出血，避免心肌梗死。
BackgroundMedullary infarction (MI) occasionally occurs after treatment of ruptured vertebral artery dissection (VAD). The aim of this study was to validate whether flow reduction for ruptured unilateral VAD by proximal clipping prevents rebleeding and MI in comparison with trapping.MethodsThirty-one patients who underwent direct surgery or endovascular procedures for unilateral ruptured VAD and postoperative magnetic resonance imaging (MRI), including 9 patients treated with trapping and 22 patients treated with proximal clipping, were enrolled. For posterior inferior cerebellar artery (PICA)–involved type VAD, occipital artery to PICA anastomosis was added as needed to isolate the rupture point. The rate of rebleeding and the occurrence of MI on MRI were compared between the 2 groups.ResultsThere was no rebleeding after treatment in all 31 patients. However, 5 patients had MI on postoperative MRI (16.1%, κ = 0.903). In 5 of the 9 patients treated with trapping, MI was seen on MRI after treatment (55.6%). On the other hand, 0 of the 22 patients treated with proximal clipping developed MI (P< 0.01).ConclusionsAppropriate flow reduction for ruptured unilateral VAD by proximal clipping is thought to be effective for preventing rebleeding and avoiding MI.