探讨症状性椎动脉起始部闭塞患者介入再通策略。

回顾性连续纳入2020年6月至2022年6月在空军军医大学第一附属医院神经内科接受介入再通治疗的症状性椎动脉起始部闭塞患者17例。分析病变特征（责任病变侧别、有无残端、对侧椎动脉情况、侧支代偿情况）、开通方式、椎动脉闭塞段处理方式、是否取栓及围手术期和随访期内的临床和影像学资料，探讨介入再通策略。

17例症状性椎动脉起始部闭塞患者中，男性15例，女性2例，中位年龄66岁。右侧椎动脉起始部闭塞患者3例，左侧椎动脉起始部闭塞患者14例，合并对侧椎动脉发育不良者13例。11例有甲状颈干的代偿供血，9例有后交通动脉的代偿供血。急性症状性椎动脉起始部闭塞开通成功率为88.8%（8/9），7例经正向开通闭塞椎动脉，1例经甲状颈干逆向指引开通闭塞椎动脉，1例因微导丝始终无法通过椎动脉起始部闭塞段而再通失败；非急性症状性椎动脉起始部闭塞开通成功率为87.5%（7/8），6例经正向开通闭塞椎动脉，1例经对侧发育不良的椎动脉逆向开通闭塞椎动脉，1例因导丝始终无法找到闭塞椎动脉开口而再通失败。17例患者中10例闭塞椎动脉有残端，7例无残端，2例未开通患者均无残端。

症状性椎动脉起始部闭塞患者介入开通主要有6种策略，首选正向开通，其次经甲状颈干、枕动脉逆向开通，再可经对侧椎动脉逆向开通或经后交通动脉逆向开通，最后可直接穿刺椎动脉逆向开通。

To investigate interventional recanalization strategies in patients with symptomatic vertebral artery ostial occlusion.

Seventeen consecutive patients with symptomatic vertebral artery ostial occlusion, who underwent interventional recanalization between June 2020 and June 2022 at the Department of Neurology, the First Affiliated Hospital of Air Force Medical University, were retrospectively enrolled. Clinical and imaging data were analyzed to assess lesion characteristics, including the side of responsible lesion, the presence or absence of stump, the presence or absence of contralateral vertebral artery, the presence or absence of collateral compensation. Additionally, the mode of access, the handling of occluded segment of vertebral artery, the success of thrombectomy retrieval, and the perioperative and follow-up periods were examined.

Seventeen patients with symptomatic vertebral artery ostial occlusion underwent interventional opening, including 15 males and 2 females, with a median age of 66 years. There were 3 patients with right vertebral artery occlusion, 14 with left vertebral artery occlusion, and 13 with contralateral vertebral artery dysplasia. Eleven cases received compensatory blood supply from the thyrocervical trunk, while 9 cases had compensatory blood supply from the posterior communicating artery. The success rate of acute symptomatic vertebral artery initial occlusion was 88.8% (8/9). Seven patients had positive occlusion of the vertebral artery; one patient had reverse guidance of the thyrocervical trunk to open the occluded vertebral artery, and in one case, recanalization failed because the micro-guide wire could not pass through the occluded segment of the vertebral artery initial; The success rate of non-acute symptomatic vertebral artery initial occlusion was 87.5% (7/8). Six cases were occluded through the positive direction; one case was occluded through the contralateral hypoplastic vertebral artery reverse direction; and one case failed to recanalize because the guide wire could not find the occluded vertebral artery opening. Of the 17 patients with occluded vertebral artery, 10 had stump, and 7 had no stump.

There are six primary strategies for achieving interventional patency in patients with symptomatic vertebral artery ostial occlusion: the first is the antegrade patency, followed by thyrocervical trunk and occipital artery retrograde patency, then contralateral vertebral artery retrograde patency or posterior communicating artery retrograde patency, and finally direct puncture of the vertebral artery retrograde patency.