PDF(Pubmed)
Abstract：
BACKGROUND: Vertebral artery stump syndrome (VASS) is a cause of acute stroke. Owing to the particularity of the pathogenesis of VASS, interventional treatment of VASS is difficult. Common mechanical thrombectomy approaches include femoral and radial artery approaches. However, conventional approaches may not be suitable for VASS. If effective measures are not taken to open offending vessels in time, this can lead to a high rate of disability. In recent years, no consensus has been reached regarding surgical methods for treating VASS.
METHODS: The patient presented to the emergency department with a 2-hour history of disturbance of consciousness.
METHODS: After neurological and magnetic resonance imaging examinations, the patient was diagnosed with acute large vessel occlusive posterior circulation cerebral infarction.
METHODS: The patient\'s symptoms were not relieved after intravenous infusion of argatroban (10 mg) at a local hospital. We first attempted to open the occluded vertebral artery through normal approaches but failed. We then punctured the vertebral artery, successfully opened the occluded vertebral artery, and performed mechanical thrombectomy.
RESULTS: The patient underwent successful vertebral artery puncture and mechanical thrombectomy, with no evidence of postoperative bleeding or vascular injury at the puncture site. The patient regained consciousness the day after surgery but remained impaired in physical activity. After 4 months of rehabilitation, the patient recovered completely.
CONCLUSIONS: When the conventional approach cannot meet the requirements of mechanical thrombectomy, reverse puncture of the vertebral artery is a feasible surgical method for patients with VASS. However, due to the small number of cases, a series of safety problems such as potential puncture failure, hemorrhage after puncture, and vascular occlusion still need to be further explored.
METHODS: The patient presented to the emergency department with a 2-hour history of disturbance of consciousness.
METHODS: After neurological and magnetic resonance imaging examinations, the patient was diagnosed with acute large vessel occlusive posterior circulation cerebral infarction.
METHODS: The patient\'s symptoms were not relieved after intravenous infusion of argatroban (10 mg) at a local hospital. We first attempted to open the occluded vertebral artery through normal approaches but failed. We then punctured the vertebral artery, successfully opened the occluded vertebral artery, and performed mechanical thrombectomy.
RESULTS: The patient underwent successful vertebral artery puncture and mechanical thrombectomy, with no evidence of postoperative bleeding or vascular injury at the puncture site. The patient regained consciousness the day after surgery but remained impaired in physical activity. After 4 months of rehabilitation, the patient recovered completely.
CONCLUSIONS: When the conventional approach cannot meet the requirements of mechanical thrombectomy, reverse puncture of the vertebral artery is a feasible surgical method for patients with VASS. However, due to the small number of cases, a series of safety problems such as potential puncture failure, hemorrhage after puncture, and vascular occlusion still need to be further explored.
摘要：
背景：椎动脉残端综合征（VASS）是急性卒中的一个原因。由于VASS发病机制的特殊性,VASS的介入治疗是困难的。常见的机械血栓切除术方法包括股动脉和桡动脉方法。然而,传统的方法可能不适合VASS。如果不采取有效措施及时开放违规船只，这可能导致高残疾率。近年来,关于治疗VASS的手术方法尚未达成共识。
方法：患者就诊于急诊科，有2小时意识障碍史。
方法：经过神经和磁共振成像检查，患者诊断为急性大血管闭塞性后循环脑梗死。
方法：患者在当地医院静脉输注阿加曲班（10mg）后症状未缓解。我们首先尝试通过正常方法打开闭塞的椎动脉，但失败了。然后我们刺穿了椎动脉,成功地打开了闭塞的椎动脉,并进行了机械血栓切除术。
结果：患者成功进行椎动脉穿刺和机械取栓，没有证据表明穿刺部位有术后出血或血管损伤。患者在手术后第二天恢复了意识，但身体活动仍然受损。经过4个月的康复，病人完全康复了。
结论：当常规方法不能满足机械血栓切除术的要求时，椎动脉反向穿刺是VASS患者可行的手术方法。然而,由于案件数量少，一系列安全问题，如潜在的穿刺失败，穿刺后出血，血管闭塞仍需进一步探讨。
方法：患者就诊于急诊科，有2小时意识障碍史。
方法：经过神经和磁共振成像检查，患者诊断为急性大血管闭塞性后循环脑梗死。
方法：患者在当地医院静脉输注阿加曲班（10mg）后症状未缓解。我们首先尝试通过正常方法打开闭塞的椎动脉，但失败了。然后我们刺穿了椎动脉,成功地打开了闭塞的椎动脉,并进行了机械血栓切除术。
结果：患者成功进行椎动脉穿刺和机械取栓，没有证据表明穿刺部位有术后出血或血管损伤。患者在手术后第二天恢复了意识，但身体活动仍然受损。经过4个月的康复，病人完全康复了。
结论：当常规方法不能满足机械血栓切除术的要求时，椎动脉反向穿刺是VASS患者可行的手术方法。然而,由于案件数量少，一系列安全问题，如潜在的穿刺失败，穿刺后出血，血管闭塞仍需进一步探讨。
