ABSTRACT
Objective To investigate the effect of endovascular treatment of vertebral basilar artery dissecting aneurysms. Methods The clinical data of 40 patients with vertebral basilar artery dissecting aneurysm admitted to Beijing Xuanwu Hospital and Haidian hospital,Capital Medical University from August 2013 to September 2014 were analyzed retrospectively. Their clinical symptoms and imaging were followed up. According to the treatment methods,they were divided into either a stent-assisted coil emboliza-tion group (group A;n = 34)or a parent artery occlusion (group B;n = 6),and according to the clinical symptoms and imaging followed-up,the efficacy was assessed at 1 year after procedure. Results The patients were followed up for 1 year after procedure,29 patients (85. 3%)were improved in group A, 1 (2.9%)was stable,and 4 (11. 8%)deteriorated. All the 4 deteriorated patients died of cerebral infarction complications (at 1 week to 6 months after procedure). The 6 patients in group B were improved compared with before procedure. No intracranial hemorrhage and ischemic events occurred. Conclusion Using the stent-assisted coil embolization technique and the parent artery occlusion technique for the treatment of the vertebral basilar artery dissecting aneurysms are relatively safe and effective.
ABSTRACT
Objective To investigate the relation between microembolic signals (MES) and vertebral basilar artery ste?nosis in patients with brainstem infarction. Methods A total of 156 patients with acute brainstem infarction, who were de?termined the cerebral infarction lesion and vertebral basilar artery stenosis by cranial magnetic resonance imaging and CT an?giography, and were monitored by transcranial Doppler via occipital window of basilar arterial MES monitoring in 7 days of the onset, were divided into microembolus signal negative group (n=136) and positive group (n=20). The clinical data were compared between two groups. The differences of different degrees of stenosis were analyzed in two groups. The differences of different locations of stenosis in patients with vertebral basilar artery stenosis were analyzed in two groups. Logistic regres?sion analysis was used to analyse the factors affecting MES. Results There were no significant differences in age, gender, history of hypertension and diabetes mellitus between the two groups (P<0.05). There were significant differences in the dif?ferent degrees of stenosis between two groups, no or mild stenosis was found in MES-negative group and severe stenosis in MES-positive group (P<0.05). There were 70 cases with no vertebral basilar artery stenosis, 86 cases with mild, moderate and severe stenosis, in which 14 cases were MES-positive and 72 cases were negative. There were significant differences in different locations of stenosis between the two groups. The proportion of multiple infarctions was significantly higher in MES-positive group than that of MES-negative group (P<0.05). The intracranial vertebral basilar artery stenosis and 75%of ver?tebral basilar artery stenosis were the independent risk factors of MES-positive. Conclusion Severe stenosis of the verte?bral basilar artery is more vulnerable to occur MES of posterior circulation, leading to cerebral infarction. Microemboli may be the cause of multiple infarctions in patients with vertebral basilar artery stenosis.
ABSTRACT
Objective To explore the way to evaluate hemodynamics of posterior circulation distal ischemia with PWI. Methods Thirty-two patients with vertebral basilar artery severe stenosis were reviewed and compared with thirty normal persons. Information and data of PWI and MRA were collected and analyzed. Following parameters were observed, index of vascular stenosis, collateral vessels, cerebral blood flow (rCBF), cerebral blood volume (rCBV), and mean transit time (rMTT). Results All the patients had at least one vertebral basilar artery with more than 70% stenosis. There were 17 cases with severe vertebral artery stenosis , 20 cases with severe basal artery stenosis , 8 cases with severe superior cerebellar artery stenosis , 17 cases with posterior cerebral artery stenosis , 22 cases with after the traffic artery open , 11 cases with soft meningeal arteries show and 12 cases with small artery show. The ratio of ROI with frontal white matter was lower than the rCBF and rCBV in the country group. MTT value was extended and P value of the parameters in both groups was less than 0.05, reflecting the statistical difference. Conclusions PWI combined with MRA can effectively evaluate the posterior circulation distal ischemia area and tissue perfusion , as well as the hemodynamic status of ischemia area.
ABSTRACT
Objective To analyse the efficacy of microvascular decompression for hemifacial spasm (HFS) caused by vertebral basilar artery compression. Methods A total of 141 patients with HFS treated by microvascular decompression in our hospital were collected in this study. The improvement of the symptoms after operation was compared between patients with HFS caused by vertebral basilar artery compression (28 cases) and patients with HFS caused by non-vertebral basilar artery compression (113 cases). Results There was no significant difference in the effective rate between the two groups of HFS (96.43%vs. 98.23%,P=0.49) with mean following-up 13.81 ± 1.57 months. And there was no significant difference in the delayed cure rate after surgery between two groups (37.04%vs. 20.72%,χ2=1.38, P>0.05). Conclusion Microvascular decompression is a safe and effective method for the treatment of HFS caused by compressed vertebral basilar artery.
ABSTRACT
Objective To investigate the morphological characteristics of vertebral-basilar artery in patients with posterior circulation ischemia vertigo. Methods The data of cerebrovascular disease related risk factors,neck CT angiography,and head MR angiography of 122 patients with posterior circulation ischemia vertigo and 60 non-vertigo volunteers with cerebrovascular disease related risk factors over the same period were analyzed retrospectively. The positive index of single factor comparison was analyzed by using multivariate logistic regression analysis. The risk factors for posterior circulation ischemia vertigo were screened,and the degree of vertebral artery stenosis and the degree of basilar artery tortuosity of the posterior circulation ischemia group were compared with those of the control group. Results (1 )The incidences of hypertension,hyperlipidemia,previous history of stroke or transient ischemic attack,vertebral artery atherosclemtic stenosis,vertebral artery variation,and basilar artery tortuosity of the posterior circulation ischemia group were 59%(n=72),55. 7%(n=68),64. 8%(n=79),41. 0%(n=50),28. 7%(n=35),and 30. 3%(n=37),respectively,and they were all significant higher than 33. 3%(n=20),31. 7%(n=19),35. 0%(n=21),15. 0%(n=9),10. 0%(n=6),and 15. 0%(n=9)of the control group. There were significant differences (all P<0. 05). (2)Vertebral artery atherosclerotic stenosis (OR,3. 891, 95%CI 1. 721-8. 800,P <0. 01),vertebral artery variation (OR,3. 231,95%CI 1. 238-8. 432,P =0.017),and basilar artery tortuosity (OR,2. 664,95%CI 1. 189-5. 972,P=0. 017)were the independent risk factors for posterior circulation ischemic vertigo. The degrees of vertebral artery stenosis and basilar artery tortuosity of the posterior circulation ischemic group were higher than those of the control group. There were significant differences (all P<0. 05). There was significant difference in the vertebral artery dominance between the degree of basilar artery tortuosity ≥grade 2 and
ABSTRACT
Objective To investigate the sensitivity and specificity of transcranial Doppler (TCD) diagnosis for intracranial posterior circulation artery stenosis or occlusion.Methods Seventy-two cases of patients treated for posterior circulation intracranial artery stenosis or occlusion were chosen,TCD and CT angiography (CTA) tests were carried out and the results were compared and analyzed.Results Compared with CTA,the sensitivity for period of posterior circulation intracranial arteries by TCD was 82.50％,while specificity reached 94.64％.Positive predictive value attained 91.67％,while negative predictive value reached 88.33％ and the accuracy was 89.58％.Conclusions TCD diagnosis for period of posterior circulation intracranial arterial has high specificity,normal sensitivity,and the highest diagnosis accuracy for intracranial segment of vertebral artery.TCD can serve as early inspecting method for intracranial artery.
ABSTRACT
Objective To investigate the long-term effect of angioplasty of patients with symptomatic vertebrobasilar artery stent.Methods Thirty-three patients with symptomatic vertebral artery stenosis who underwent endovascular treatment stent.The clinical symptoms and stent restenosis were recorded.Results The clinical symptoms of 33 cases with angioplasty were improved significantly.The preoperative stenosis rate was (92.36 ±3.23)％ before operation and the average postoperative residual stenosis rate was (9.13 ±2.57)％ after operation.Clinical symptoms of 23 patients disappeared completely after operation,and 10 cases improved significantly.As to complications,1 case with severe basilar artery stenosis had a side numbness of extremities,1 case showed postoperative cerebral embolism,and return to normal after 3 days.When follow up periods lasted for 6-24 months,9 cases were with dizziness or other symptoms.Of which,29 cases were performed DSA imaging,the residual stenosis rate was (19.27 ± 5.62)％,3 cases of vertebral artery in-stent restenosis were reached over 50％.Those 3 cases were give stent angioplasty again and the uncomfortable symptoms disappeared.Conclusion Stenosis opeation can significantly alleviate the symptoms of cerebral ischemia and symptomatic vertebrobasilar artery,and improve the quality of life of patients.However,restenosis should paid more attention.
ABSTRACT
Objective From the angle of electrophysiology, go further into the mechanism of action of acupuncture treatment to the insufficient blood-supply of vertebral basilar artery and at the same time, make a comparison of the effects between the acupuncture on cephalic meridian points and zonation cephalic acupuncture. Methods Through the contrast before and after adopting the self-acupuncture on the testees of 28 cases (including healthy persons of seven cases and TIA patients of 21 cases), observe the change of immediate effect of all waves latent period values of BAEP. Results The BAEP wave latent period of healthy persons (exclusive of I wave of auditory fainting region) assumes a relative delay within the physiological range and by comparison between points and region, the delay of V-wave Baihui point is evidently higher than that of auditory fainting region. However, the latent period of all waves of TIA patients is relatively moved up, especially there are evident differences before and after the I-wave acupuncture is carried out. Viewing from the comparison between points and region, there is no significant difference. Conclusion The function of acupuncture lies in the adjustment of antagonistic body state and it is most effective under the pathological state. Acupuncture will play the main role of excitation to the auditory nerve conduction of BAEP of TIA patients (from cochlea to midbrain) and the influence over the peripheral nerves is more sensitive than over the center ones. Although points and region have their own relative specificities, there is no significant difference between them.
ABSTRACT
Objective To investigate the diagnostic value of SPECT,TCD and BAEP to vertebral basilar artery ischemia vertigo Methods 100 cases of vertebral basilar artery ischemia vertigo were inspected by SPECT,BAEP and TCD All the results were analyzed and compared Results Among 100 cases, it shows that the diagnostic rate of SPECT is 80 percent,BAEP is 58 3 percent and TCD is 78 percent Conclusion SPECT is found having the highest diagnostic rate,it sensitively and accurately reflects the position of cerebral ischemia Although BAEP having the lowest diagnostic rate, it can still effectively shows Brain Stem Ischemia Comparing with SPECT and BAEP, TCD is simple and convenient to carry out It sensitively reflects the conditions of cerebral vessel and cerebral blood stream,but it is insensitive to make sure the position Therefore, three of them offer the valuable,external and diagnostic proof to vertebral basilar artery ischemia vertigo,and they can have a role of inter reinforce
ABSTRACT
Objective To evaluate the curative effect of stent angioplasty for treatment vertebral basilar artery stenosis. Methods 34 patients with vertebral basilar artery stenosis diagnosed by DSA were treated with cerebral angioplasty and stenting(CAS ) operation by flexible balloon expandable stents. Results 36 stents were placed in 34 patients. The achievement ratio of operation was 100%. All stenosis showed by DSA were successfully improved without complications.The mean stenosis rate of preoperation and postoperation were (78.3?6.2)% and (3.6?4.2)% respectively. During the further follow up period of 6～38 months, clinical symptoms were disappeared in 31 patients, relieved in 2 patients, recurred in 1 patient.There were no vertebro-basilar system transient ischemic attack and brain infarction onset in those patients.Conclusion Stent angioplasty is safe and effective in the treatment of symptomatic vertebral artery stenosis.
ABSTRACT
By means of the introarterial-injected preparations with oil dye(in some caseswith neuprene latex),the cerebral arterial circle and vertebral-basilar artery of camel(Bactrianus Camelus)were studied in 15 cases.The results obtained are as follows:1.The cerebral arterial circle is composed of two parts,and is formed by theinternal carotid artery intracranial segments and the caudal communicating arteriesas well as their branches of both sides,respectively.66.7 per cent of the caudalcommunicating arteries originate from the carotid rete,33.3 per cent from the inter-nal carotid artery intracranial segment.Anastomosis was found between these twovessels in 46.7 per cent and 20.0 per cent has no communicating branches.This isdifferent from other mammals.The average diameters of the two vessels are 0.216+0.057 cm and 0.178+0.056 cm,respectively.The circle gives the following vessels:rostral cerebral arteries,middle cerebral arteries,caudal cerebral arteries,and thecaudal segment of basilar artery.2.After receiving the branches of occipital artery,the vertebral artery entersinto the cranial cavity and divides to form the cerebral-spinal circle together withbranches on the opposite side.The circle gives rise to the caudal segment of basilarartery and ventral spinal artery.3.The course of the basilar artery differs in no way from the usual patternfound in other mammals,but it is of interest to note that the calibre of this vesselindicate the flow of the blood away the cerebral arterial circle as well as the cere-bral-spinal circle.The vessels arisen from the basilar artery are rostrol cerebellararteries,caudal cerebellar arteries,postpone branches and medullary branches.