椎-基底动脉延长扩张症的诊疗进展

doi:10.19854/j.cnki.1008-2425.2023.06.0010

摘要/Abstract

摘要： 椎-基底动脉延长扩张症(vertebrobasilardolichoectasia,VBD)是临床少见的一种脑血管病,以椎动脉(vertebral artery,VA)和(或)基底动脉(basilar artery,BA)的管壁扩张、管道冗长且走行迂曲为主要特征。VBD最常见的临床表现是缺血性卒中,此外还可出现脑干或脑神经受压、脑积水、颅内出血等非特异性症状。该病预后差且尚无特效治疗手段,确诊主要依赖影像学检查。得益于检查技术的进步,近些年来该病的检出率有逐年升高的趋势。本文主要针对近些年来关于VBD的诊断和治疗取得的进展做综述如下。

关键词: 颅内动脉延长与扩张症, 椎-基底动脉延长扩张症, 椎动脉, 基底动脉

中图分类号:

R743

李正斌, 杨文桢, 杨宝慧, 史雪峰, 田川, 张新定. 椎-基底动脉延长扩张症的诊疗进展[J]. 立体定向和功能性神经外科杂志, 2023, 36(6): 369-375.

参考文献

[1] Zhang DP,Yin S,Zhang HL,et al.Association between intracranial arterial dolichoectasia and cerebral small vessel disease and its underlying mechanisms[J].Journal of Stroke,2020,22(2):173~184.
[2] 韩金涛,乔惠婷,韩旭,等.椎基底动脉延长扩张症的计算流体力学分析[J].北京大学学报 (医学版),2015,47(2):302~304.
[3] Brinjikji W,Chung B,Yong-Hong D,et al.Hemodynamic characteristics of stable and unstable vertebrobasilar dolichoectatic and fusiform aneurysms[J].Journal of NeuroInterventional Surgery,2018,10(11):1102~1107.
[4] Pico F,Jacob MP,Labreuche J,et al.Matrix metalloproteinase-3 and intracranial arterial dolichoectasia[J].Annals of neurology,2010,67(4):508~515.
[5] Gutierrez J,Menshawy K,Goldman J,et al.Metalloproteinases and brain arterial remodeling among individuals with and those without HIV infection[J].The Journal of Infectious Diseases,2016,214(9):1329~1335.
[6] Zheng T,Tang W,Shan Y,et al.Studying the imaging features and infarction mechanism of vertebrobasilar dolichoectasia with high-resolution magnetic resonance imaging[J].Brain Pathology,2023,33(2):e13135.
[7] Förster A,Wenz R,Maros ME,et al.Anatomical distribution of cerebral microbleeds and intracerebral hemorrhage in vertebrobasilar dolichoectasia[J].Plos one,2018,13(4):e0196149.
[8] Liu JJ,O’neill BE,Mazur-Hart D,et al.A technical note on anterolateral mobilization in vertebrobasilar dolichoectasia for relief of brainstem compression[J].Journal of Cerebrovascular and Endovascular Neurosurgery,2022,24(3):297~302.
[9] 龚瑾,林立建,谢良地.椎基底动脉延长扩张症与高血压[J].中华高血压杂志,2019,27(6):525~529.
[10] Li Q,Xie P,Yang W-S,et al.Vertebral artery compression syndrome[J].Frontiers in Neurology,2019,10:1075.
[11] Samim M,Goldstein A,Schindler J,et al.Multimodality imaging of vertebrobasilar dolichoectasia:clinical presentations and imaging spectrum[J].Radiographics,2016,36(4):1129-1146.
[12] Lin A,Rawal S,Agid R,et al.Cerebrovascular imaging:which test is best?[J].Neurosurgery,2018,83(1):5-18.
[13] 任志军,李孟修,王丹,等.DSA 对缺血性卒中并椎基底动脉延长扩张症患者的临床应用价值[J].中国实用医刊,2018,45(23):16~18.
[14] Shaban S,Huasen B,Haridas A,et al.Digital subtraction angiography in cerebrovascular disease:Current practice and perspectives on diagnosis,acute treatment and prognosis[J].Acta Neurologica Belgica,2021:1~18.
[15] Hussein ZA,Al-Tameemi HN,Hassoun HK,et al.Transcranial doppler findings in basilar artery dolichoectasia:a case control study[J].American Journal of BioMedicine,2021,9(4):177~188
[16] 吴雪峰,陈丽,邵宝富.缺血性脑卒中合并VBD的TCD特点及MRI影像特征分析[J].中国CT和MRI杂志,2022,20(11):23-~25.
[17] 王超,裴昌军,王美娟,等.椎基底动脉扩张延长症的CT诊断[J].中国医学计算机成像杂志,2019,25(1):8~11.
[18] Liebeskind DS,Woolf GW,Zubak JM,et al.Abstract TMP38:Vertebrobasilar Dolichoectasia is a distinct subtype of intracranial large artery disease:computational fluid dynamics of hemodynamic abnormalities[J].Stroke,2016,47(suppl_1):ATMP38-ATMP.
[19] Smoker W,Corbett J,Gentry L,et al.High-resolution computed tomography of the basilar artery:2.Vertebrobasilar dolichoectasia:clinical-pathologic correlation and review[J].American journal of neuroradiology,1986,7(1):61~72.
[20] Parera C,Abruzzi M,Lehkuniec E,et al.Dolichoectatic intracranial arteries.Advances in images and therapeutics[J].Medicina,1995,55(1):59-68.
[21] Ubogu E,Zaidat O.Vertebrobasilar dolichoectasia diagnosed by magnetic resonance angiography and risk of stroke and death:a cohort study[J].Journal of Neurology,Neurosurgery & Psychiatry,2004,75(1):22~26.
[22] Fatima Z,Motosugi U,Okumura A,et al.Basi-parallel anatomical scanning (BPAS)-MRI can improve discrimination of vertebral artery dissection from atherosclerosis and hypoplasia[J].Academic radiology,2012,19(11):1362~1367.
[23] 张志勇,张海波,焦劲松,等.基底平行解剖扫描磁共振成像在颅内椎-基底动脉病变中的应用价值[J].中国脑血管病杂志,2020,17(9):531-537.
[24] Vranic JE,Hartman JB,Mossa-Basha M.High-resolution magnetic resonance vessel wall imaging for the evaluation of intracranial vascular pathology[J].Neuroimaging Clinics,2021,31(2):223~233.
[25] Zhu X,Shan Y,Guo R,et al.Three-Dimensional High-Resolution Magnetic Resonance Imaging for the Assessment of Cervical Artery Dissection[J].Frontiers in Aging Neuroscience,2022,14.
[26] Zheng T,Liu L,Li L,et al.Case Report:Advantages of High-Resolution MRI in Evaluating the Efficacy of Drug Therapy for Intracranial Atherosclerotic Plaques[J].Frontiers in Aging Neuroscience,2022,14.
[27] Ruiz-Juretschke F,Guzman-de-Villoria J G,García-Leal R,et al.Predictive value of magnetic resonance imaging for identifying neurovascular compressions in trigeminal neuralgia[J].Neurología (English Edition),2019,34(8):510~519.
[28] 石海亮,李洋,郭文昌.神经血管三维重建在术前诊断 VBD 合并 HFS 患者神经血管关系和责任血管中的应用[J].中华神经医学杂志,2020,19(12):1194G1199.
[29] Zhang DP,Peng YF,Zhang HL,et al.Basilar artery tortuosity is associated with white matter hyperintensities by TIMP-1[J].Frontiers in Neuroscience,2019,13:836.
[30] Zhang HL,Peng YF,Zhang DP,et al.MMP-9,vertebrobasilar ectasia and vertebral artery dominance in vertigo or dizziness patients with vascular risk factors[J].Frontiers in Neurology,2020,11:931.
[31] Liu Y,Zhu J,Deng X,et al.Serum level of lipoprotein-associated phospholipase A2 is a potential biomarker of vertebrobasilar dolichoectasia and its progression to cerebral infarction[J].Neurological Sciences,2021,42:599~605.
[32] Matsumoto K,Yamada K,Hayakawa T,et al.Dolichoectatic Basilar Artery Treated by Reducing Hemodynamic Stress—Report of Two Cases—[J].Neurologia medico-chirurgica,1990,30(9):691~694.
[33] Frisoli FA,Srinivasan VM,Catapano JS,et al.Vertebrobasilar dissecting aneurysms:microsurgical management in 42 patients[J].Journal of Neurosurgery,2021,137(2):393~401.
[34] O'shaughnessy BA,Getch CC,Bendok BR,et al.Progressive growth of a giant dolichoectatic vertebrobasilar artery aneurysm after complete Hunterian occlusion of the posterior circulation:case report[J].Neurosurgery,2004,55(5):E1228~E1235.
[35] Zhang H,Shi M,Tong X.Treatment of symptomatic dolichoectatic vertebrobasilar aneurysms:a single-center experience with 12 patients[J].World Neurosurgery,2018,119:e407~e416.
[36] He X,Duan C,Zhang J,et al.The safety and efficacy of using large woven stents to treat vertebrobasilar dolichoectasia[J].Journal of NeuroInterventional Surgery,2019,11(11):1162~1166.
[37] 路智文,吴曦,刘建民,等.重叠多支架置入术治疗椎动脉延长扩张症的初步经验[J].中国脑血管病杂志,2017,8.
[38] Adeeb N,Ogilvy CS,Griessenauer CJ,et al.Expanding the indications for flow diversion:treatment of posterior circulation aneurysms[J].Neurosurgery,2020,86(Supplement_1):S76~S84.
[39] Fiorella D,Kelly ME,Albuquerque FC,et al.Curative reconstruction of a giant midbasilar trunk aneurysm with the pipeline embolization device[J].Neurosurgery,2009,64(2):212~217.
[40] Bender MT,Colby GP,Jiang B,et al.Flow diversion of posterior circulation cerebral aneurysms:a single-institution series of 59 cases[J].Neurosurgery,2019,84(1):206~216.
[41] 张永智,亓敬涛,刘彬冰,等.血流导向装置治疗未破裂椎动脉夹层动脉瘤 11 例临床分析[J].中华解剖与临床杂志,2021,26(4):431~434.
[42] McDougall CG,Diaz O,Boulos A,et al.Safety and efficacy results of the Flow Redirection Endoluminal Device (FRED) stent system in the treatment of intracranial aneurysms:US pivotal trial[J].Journal of neurointerventional surgery,2022,14(6):577~584.
[43] Salem M M,Kvint S,Hendrix P,et al.The Pennsylvania postmarket multicenter experience with flow redirection endoluminal device[J].Neurosurgery,2022,91(2):280~285.
[44] Griessenauer CJ,Enriquez-Marulanda A,Xiang S,et al.Comparison of PED and FRED flow diverters for posterior circulation aneurysms:a propensity score matched cohort study[J].Journal of neurointerventional surgery,2021,13(2):153~158.
[45] 张道培,刘飞祥,王伟涛,等.加味通窍活血汤对瘀血阻络证椎基底动脉延长扩张症后循环血流量和管壁剪切力的影响[J].中国实验方剂学杂志,2020,26(14):35~41.
[46] Liu B,Granville DJ,Golledge J,et al.Pathogenic mechanisms and the potential of drug therapies for aortic aneurysm[J].American Journal of Physiology-Heart and Circulatory Physiology,2020,318(3):H652~H670.
[47] Baxter BT,Matsumura J,Curci JA,et al.Effect of doxycycline on aneurysm growth among patients with small infrarenal abdominal aortic aneurysms:a randomized clinical trial[J].Jama,2020,323(20):2029~2038.
[48] Panthofer A M,Olson S L,Rademacher BL,et al.Infrarenal Aortic Neck Diameter Is Unaltered by Treatment With Doxycycline[J].Journal of Vascular Surgery,2020,72(1):e7~e8.
[49] Raffort J,Hassen-Khodja R,Jean-Baptiste E,et al.Relationship between metformin and abdominal aortic aneurysm[J].Journal of vascular surgery,2020,71(3):1056~1062.
[50] Li S,Shi Y,Liu P,et al.Metformin inhibits intracranial aneurysm formation and progression by regulating vascular smooth muscle cell phenotype switching via the AMPK/ACC pathway[J].Journal of Neuroinflammation,2020,17(1):1~15.
[51] Kleindorfer D O,Towfighi A,Chaturvedi S,et al.2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline from the American Heart Association/American Stroke Association[J].Stroke,2021,52(7):e364~e467.
[52] Sari PM,Sani AF,Kurniawan D.Intravenous thrombolysis in patient with vertebrobasilar dolichoectasia and antiplatelet medication[J].Radiology Case Reports,2022,17(9):3355~3359.
[53] Sokolov AA,Husain S,Sztajzel R,et al.Fatal subarachnoid hemorrhage following ischemia in vertebrobasilar dolichoectasia[J].Medicine,2016,95(27):e4020.
[54] Saliou G,Sacho RH,Power S,et al.Natural history and management of basilar trunk artery aneurysms[J].Stroke,2015,46(4):948~953.
[55] Zhao Z,Chai S,Wang J,et al.Comparison of microvascular decompression and two isocenters gamma knife for the treatment of trigeminal neuralgia caused by vertebrobasilar dolichoectasia[J].Frontiers in Neurology,2021:1296.
[56] Tambasco N,Filidei M,Nigro P,et al.Botulinum toxin for the treatment of hemifacial spasm:an update on clinical studies[J].Toxins,2021,13(12):881.
[57] Greve T,Tonn JC,Mehrkens JH.Microvascular decompression for trigeminal neuralgia in the elderly:efficacy and safety[J].Journal of neurology,2021,268:532~540.
[58] Seshadri R,Sadashiva N,Shukla D,et al.Vertebrobasilar dolichoectasia presenting as symptomatic obstructive hydrocephalus:A case report with review of literature[J].Indian Journal of Neurosurgery,2012,1(2):165~168.
[59] Karasudani K,Ito Y,Muroi A,et al.Endoscopic third ventriculostomy for noncommunicating hydrocephalus by vertebrobasilar dolichoectasia:A case report[J].Surgical Neurology International,2022,13.