高分辨磁共振血管壁成像在症状性基底动脉狭窄血管内治疗中作用的初步探讨

Objective: The aim of the study was to preliminarily determine the role of preoperative high-resolution magnetic resonance imaging vessel wall imaging (HRMR-VWI) in endovascular treatment of severe symptomatic basilar artery (BA) stenosis. Methods: The clinical data of 15 patients with severe symptomatic BA stenosis (≥70% stenosis) who were admitted to Department of Neurointervention, Beijing Anzhen Hospital, Capital Medical University from April 2019 to April 2020 were retrospectively analyzed. All patients underwent HRMR-VWI prior to operation for assessment of the site of atherosclerotic plaques, vulnerability of plaques, and their relationship with major branch arteries. Among the 15 patients, 2 cases underwent balloon dilatation alone and 13 cases underwent balloon dilatation combined with stenting. The perioperative complications, mortality, the modified Rankin Scale (mRS), and adverse events were clinically followed up. Restenosis of BA was assessed by imaging follow-up. Results: The results of preoperative HRMR-VWI of 15 patients indicated that the atherosclerotic plaques were located on the dorsal side of BA in 9 cases, ventral side in 2, on the left-side wall in 7, and right-side wall in 6. Vulnerable plaques were identified in 4 cases. The atherosclerotic plaques were adjacent to the left anterior inferior cerebellar artery in 2 patients, and located at the lower segment of BA and the junction of bilateral vertebral arteries in 5 patients. Within 30 days post operation, 1 transient ischemic attack was reported in 1 patient and no hemorrhagic stroke or death occurred in 15 patients. All 15 patients were clinically followed up for a median of 7.5 months (range: 5.0-9.0 months) and there was no stroke or death. The median mRS score at the latest follow-up was 1 point (range: 0-1 point). Eight patients underwent imaging follow-up at 6 months post operation, out of whom 1 patient reported the restenosis of 50% and 7 did not have the restenosis of ≥50%. Conclusions: This preliminary study has suggested that for the treatment of severe symptomatic BA stenosis, HRMR-VWI could be used to assess the location and vulnerability of stenotic plaques, as well as their relationship with major branch arteries. Moreover, it is helpful to increase the safety of endovascular treatment before operation.