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中华脑血管病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (04) : 394 -399. doi: 10.11817/j.issn.1673-9248.2023.04.015

临床病例研究

以Wallenberg综合征起病的椎动脉颅外段闭塞介入治疗探讨
袁兴运, 陈万红, 鱼丽萍, 姚力()   
  1. 712000 陕西咸阳,咸阳市第一人民医院神经内科
    710077 西安,西电集团医院神经内科
  • 收稿日期:2023-02-12 出版日期:2023-08-01
  • 通信作者: 姚力
  • 基金资助:
    陕西省中医药管理局2021-2022年度科研项目(2021-ZZ-LC033); 中国卒中学会脑血管病全程管理项目一启航基金(202001)

Interventional treatment of vertebral artery occlusion with Wallenberg syndrome

Xingyun Yuan, Wanhong Chen, Liping Yu, Li Yao()   

  1. Department of Neurology, the First People's Hospital of Xianyang, Xianyang 712000, China
    Department of Neurology,XD Group Hospital, Xi'an 710077, China
  • Received:2023-02-12 Published:2023-08-01
  • Corresponding author: Li Yao
引用本文:

袁兴运, 陈万红, 鱼丽萍, 姚力. 以Wallenberg综合征起病的椎动脉颅外段闭塞介入治疗探讨[J/OL]. 中华脑血管病杂志(电子版), 2023, 17(04): 394-399.

Xingyun Yuan, Wanhong Chen, Liping Yu, Li Yao. Interventional treatment of vertebral artery occlusion with Wallenberg syndrome[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2023, 17(04): 394-399.

目的

探讨介入治疗对椎动脉颅外段闭塞引起的Wallenberg综合征(又称延髓背外侧综合征)的安全性和有效性。

方法

收集2022年9月至2023年1月在咸阳市第一人民医院(4例)和西电集团医院(2例)急诊介入再通的6例椎动脉颅外段闭塞引起的Wallenberg综合征患者的临床资料,回顾性分析患者的基本资料、术前症状、闭塞血管、血管再通分级、手术并发症、24 h临床症状及体征变化、90 d 改良Rankin量表(mRS)评分等情况。

结果

6例发病时间:最短5 h,最长5 d;责任血管均为左侧椎动脉(VA);6例患者VA均获得开通,所有患者术后24 h头晕/眩晕等主观症状均明显减轻,1例在开通过程中发生血栓逃逸,采用中间导管抽吸后无症状。6例90 d mRS评分均预后良好。

结论

对于VA闭塞起始处急性闭塞引起的Wallenberg综合征急诊介入开通治疗安全可行,可明显减轻患者主观症状。

Objective

To explore the safety and efficacy of interventional therapy for the Wallenberg syndrome (dorsolateral medullary syndrome) caused by extracranial vertebral artery occlusion.

Methods

The clinical data of 6 patients with Wallenberg syndrome caused by extracranial vertebral artery occlusion who received emergency interventional recanalization in the First People's Hospital of Xianyang and XD group Hospital from September 2022 to January 2023 were collected, and the basic data of the patients were retrospectively analyzed, including preoperative symptoms, occlusion of blood vessels, recanalization grade, surgical complications, changes in clinical symptoms and signs at 24 hours, mRS score at 90 days, etc.

Results

The range of onset time in 6 cases was from 5 hours to 5 days. All responsible vessels were left vertebral arteries. The vertebral arteries were re-opened in all 6 patients, and the subjective symptoms such as dizziness/vertigo were significantly relieved in all patients 24 hours after the operation. One patient had thrombosis escape during the opening process, and had no symptoms after using intermediate catheter aspiration. mRS score at 90 days was good in all 6 patients.

Conclusion

Emergency intervention for Wallenberg syndrome caused by acute occlusion at the beginning of vertebral artery occlusion is safe and feasible, which can significantly alleviate patients' discomfort.

表1 6例Wallenberg综合征患者临床资料
图1 47岁男性Wallenberg综合征患者左侧椎动脉(VA)闭塞介入治疗过程。患者突发眩晕6 h,诊断为Wallenberg综合征,其中图a为延髓背外侧梗死,箭头为左侧延髓背外侧梗死病灶;图b为左侧VA闭塞;图c为右侧VA纤细;图d为数字减影血管造影见左VA起始处闭塞,远端可见肌支代偿显影;图e为保护伞保护下开通,可见VA内血栓;图f为导管抽吸血栓,可见保护伞收住部分血栓;图g为VA起始处植入支架,基底动脉血流通畅
图2 43岁男性Wallenberg综合征患者左侧椎动脉(VA)闭塞介入治疗过程。患者头晕伴恶心3 d,诊断为Wallenberg综合征,其中图a为左侧小脑及延髓弥散高信号,箭头为血栓影与长鞘位置;图b为右侧VA纤细,V4段发育不良;图c为左VA起始处闭塞;图d为保护伞保护下开通,可见VA新鲜血栓;图e为长鞘跟进抽吸出大量血栓,显示VA起始处狭窄;图f为VA开口处植入球扩支架;图g为左VA及基底动脉血流通畅,无血栓逃逸
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