进展性后循环缺血中非急性椎基底动脉闭塞的血管内再通：一例病例报告

文献信息

中文摘要

背景： 与急性基底动脉闭塞不同，非急性椎基底动脉闭塞的干预证据有限，需要个体化风险评估。
病例介绍： 一名62岁女性在十天内出现进行性眩晕、复视、构音障碍和步态共济失调。在怀疑后循环缺血后开始双联抗血小板治疗，但症状继续进展。MRI显示急性至亚急性左侧小脑梗死，CTA显示基底动脉顺行显影缺失伴远端侧支充盈。DSA显示左侧椎动脉远端闭塞、经后交通动脉侧支逆行充盈基底动脉以及右侧椎动脉发育不良。经多学科评估和知情同意后实施血管内再通。腔内穿越、逐步血管成形术和支架重建恢复了基底动脉顺行血流，无血管造影并发症。出院时NIHSS从5改善至2，30天时mRS为1。无随访血管影像资料。
结论： 本病例说明在选择的非急性椎基底动脉闭塞中技术可行，但并不能确立药物治疗失败、因果性恢复、可推广的安全性，或长期耐久性。

英文摘要

BACKGROUND: Unlike acute basilar artery occlusion, non-acute vertebrobasilar occlusion has limited evidence for intervention and requires individualized risk assessment.
CASE PRESENTATION: A 62-year-old woman developed progressive vertigo, diplopia, dysarthria, and gait ataxia over ten days. Dual antiplatelet therapy was started after posterior circulation ischemia was suspected, but symptoms continued to progress. MRI showed acute to subacute left cerebellar infarction, and CTA showed absent antegrade basilar opacification with collateral distal filling. DSA showed distal left vertebral artery occlusion, retrograde basilar filling through posterior communicating artery collaterals, and hypoplastic right vertebral artery. Endovascular recanalization was performed after multidisciplinary review and informed consent. Intraluminal crossing, stepwise angioplasty, and stent reconstruction restored antegrade basilar flow without angiographic complications. NIHSS improved from 5 to 2 at discharge, and mRS was 1 at 30 days. No follow-up vascular imaging was available.
CONCLUSIONS: This case illustrates technical feasibility in selected non-acute vertebrobasilar occlusion, but does not establish medical treatment failure, causal recovery, generalizable safety, or long-term durability.