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Basilar artery stenosis stenting in 1 case report

Hg or so, not taking antihypertensive drug treatment system, 4 years of occult coronary heart disease, diabetes deny, deny hepatitis, tuberculosis and other infectious diseases history of lacunar infarction 2 years (clinically asymptomatic), tobacco 3O years ( 1 box / 2d), has quit, no alcohol addiction, family genetic history of cerebrovascular disease-free. No previous ulcer, liver and kidney disease,[link widoczny dla zalogowanych], no major surgery within 2 weeks, not with anticoagulant medication. Examination before thrombolysis: Bp150/90mmHg, P8O [~ / min, R20 ~ / min, T37 ℃, light coma, two pupil diameter 3mm, light reflex exists, as the position under the right eye, two weak gag reflex, limb muscle strength 0, the pathological lower limbs (+), neck without resistance, g's sign (a), normal cardiopulmonary auscultation. Let stand before the examination: look, mild dysarthria,[link widoczny dla zalogowanych], bilateral decreased gag reflex, slightly worse on the right limb muscle strength, muscle tone right limbs slightly, a little right of tendon reflexes active cases of reflex was not elicited. Head CT examination: the left corona radiata lacunar infarction. ECG showed sinus rhythm, generally normal ECG. Blood, coagulation, blood sugar, normal renal function, high blood triglycerides, the incidence line DSA,[link widoczny dla zalogowanych], 2h: distal basilar artery occlusion, bilateral posterior cerebral artery did not develop. Intracranial vascular ultrasound; basilar artery and the left vertebral artery blood flow velocity was faster, bilateral posterior cerebral artery blood flow velocity Pianman, the sound rough basilar artery, the frequency window of disorder, the spectrum shape is not normal, blood vessel elasticity decreased. AGED diagnosis: ① basilar artery stenosis; ② transient ischemic attack (a vertebral basilar arterial system, arterial atherosclerosis); ③ 4.3 lacunar infarction, hypertension, very high-risk stratification. 1 point NIHSS score before surgery, the incidence 4:0 O pm in the afternoon local anesthesia and ECG, blood pressure, oxygen saturation monitor, the line of cerebral angiography within + basilar artery stenosis stenting. 1h before surgery pumped nimodipine, patients who have given regular heparin 3000U pot (after 500U / h), after a successful surgery, after review of the first CT, no hemorrhage, surgery continues to unfractionated heparin 500U / h, to 7pm, pull out the arterial sheath after 2h, 8pm start giving low molecular weight heparin 4000U, 1 time / 12h, with 1 week treatment with anti-platelet aggregation before operation. After 3d,[link widoczny dla zalogowanych], to walk with, NIHSS score 1 point, after 10d of patients discharged from hospital. Review 1 month after blood, liver and kidney functions coagulation were normal, blood triglycerides are still high. Vascular ultrasound showed bilateral intracranial vertebral artery blood flow velocity in normal, morphologically normal spectrum, the base slightly increased arterial blood flow velocity, spectrum a little disorder. 2 Cerebrovascular disease is discussed common and frequently-occurring disease of the nervous system, and ischemic cerebrovascular disease and cerebrovascular disease accounted for the majority. In recent years, the treatment of ischemic cerebrovascular disease progress rapidly,[link widoczny dla zalogowanych], such as ultra-early thrombolytic therapy, but the ultra-early thrombolytic therapy can only block the blood vessels open, can not solve the problem of stenosis. Endovascular stent people can narrow blood vessels to dilate to nearly the diameter of normal vessels, play the role of drugs would not achieve. The basilar artery in patients with recurrent TLA, hypertension, coronary heart disease and a history of lacunar infarction, long-term smoking, high blood triglycerides, reasons to consider artery atherosclerosis. The patient had distal occlusion of the basilar artery occurred immediately to give arterial thrombolysis, after 1 week, the patient is able to walk with, but stenosis is not fundamentally resolved, after oral administration of aspirin and Bo Liwei While insisting still attack 2, and hospitalization. Finally, families who agreed to the treatment of intravascular stent, blood vessel immediately after opening, no adverse reactions, a good postoperative recovery, the laboratory tests are normal. We believe that doctors in particular, nerve physicians should deepen understanding of cerebral angiography, cerebral vascular diseases, especially, rLA and understanding of SAH. Conditions, MRA or CTA should be routinely done and vascular ultrasound examination, CT perfusion and diffusion can do is better, it can be used to determine whether a narrow relevant regional ischemia, can be used to determine the intravascular stent's efficacy, but also for guiding thrombolytic therapy. Examination revealed stenosis and aneurysm, vascular malformation, patients should be mobilized to do the whole cerebral angiography and found that severe stenosis, time to do endovascular stent placement. Aneurysms and vascular malformations also can be involved in treatment. In this way, doctors can not only improve the understanding of brain diseases, but also improve the therapeutic effect of cerebrovascular disease, play the role of drugs would not achieve in order to improve treatment of cerebrovascular disease a bad situation, reducing cerebrovascular disease disability. In conclusion, endovascular stent placement in the treatment of ischemic cerebrovascular disease is a very promising approach, should be more to carry out this work, gain experience, to benefit patients with cerebrovascular disease. [Received date :2009-03-21 Editing: Wang Lina]
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