Anatomical Basis Of Perforator Artery And Clinical Study About Top Of The Basilar Artery Syndrome After Posterior Circulation Interventional Operation

Objective:To provide anatomic basis for recognizing the perforators of basilar artery in neurointervention and evaluating the risk of operation.To summarize the incidence and clinical characteristics of the top of the basilar artery syndrome after or during interventional operation through analyzing the clinical and imaging data of patients.Methods:(1)Traditional methods of anatomy was used to take 14 adult brains.The anatomic features of the perforator branches of basilar artery were observed and recorded.(2)20 cases of cerebrovascular angiography without influence on posterior circulation blood flow were selected.the verteral arteries were rotated in 2D and imaged in 3D by accurate delayed exposure,then recognized and counted the perforators which displayed in the images of 2D/3D-rotation or 3D-reconstruction through combining anatomical basis for the identification of perforating arteries and statistics analysis;(3)The results of perforators of basilar artery in DSA and anatomy were to contrastively analyzed.Collected the clinical and imaging data of patients in the First Affiliated Hospital of Kunming Medical University Department of Radiology from January 2009 to July 2017 who suffered top of the basilar artery syndrome after or during interventional operation.Analyze the disease incidence,pathogenesis,Imaging features and clinical manifestations of postoperative of top of the basilar artery syndrome.The operation risk factors of this complication were summarized.Results:DSA angiography of Basilar artery showed long circumflex artery of the brainstem feeding artery with an average of 0.6 per side and an anatomical result of 1.6 periarterial side(P<0.05).Angiography showed that the thalamoperforating arteries with an average of 2.2 branches per side,with anatomic result of 2.9 per side(P<0.05),an medial posterior choroidal artery of 0.6 per side,an anatomical result of 0.95 per side,Long circumflex artery artery of 0.45 per side with an anatomical result of 1.0 per side(P<0.05).There were 6 cases which suffered TOBS,the incidence rate was 13.95%.2 cases with serious clinical outcome,the incidence rate was 4.8%of 43 patients.Aneurysm embolism combined with severe outcome in 1 case,accounting for 5.2%of aneurysm cases,AVM on posterior circulation with severe outcome in 1 case,accounting for 5%of AVM cases.Conclusion:DSA plays an important role in the recognition of perforating branches.It can be used to evaluate the surgical risk and the prognosis of patients.Main reasons that cause top of the basilar artery syndrome were vascular oclusion caused by excessive embolism which leading to coil displacement;cerebral infarction caused by vasospasm after hydrocephalus;ischemia on perforator artery blood supply area after embolic operation.Acute ischemic manifestations of the temporal parietal occipital region,the cerebellum,and the thalamus were shown by imaging.Severe complication can lead to live as plant man or even death.However,most of the patients with TOBS can benefit from the treatment of the nutritional nerve and nerve function stimulation.