| Objective:To avoide damaging the posterior circulation perforators and provide technique and anatomic basis for recognizing and assessing the perforators in neurointervention surgery through evaluation of optimal vertebral artery angiography and instructing vertebral artery angiography via observation of microsurgical anatomy.Methods:(1)80 patients in our hospital from March to July 2017 who needed to do posterior circulation cerebral brain DSA examination were randomed divided into control group(normal vertebral artery angiography,40 cases,2D DSA:flow rate of 3ml/s,total flow of 5ml;3D DSA:flow rate of 3ml/s,total flow of 15 ml,exposure delay time of 1.5-2.0s,detector format size set to 48or42)and experimental group(optimized vertebral artery angiography,40 cases,2D DSA:flow rate of 4ml/s,total flow of 6ml;3D DSA:flow rate of 4ml/s,total flow of 20-24ml,exposure delay time of 3-4s,detector format size set to 22).Observed the basilar artery and proximal posterior cerebral artery on both sides in different modes after angiography,and counted the two groups differences of the numbers of each segments perforators.(2)14 adult brains under traditional methods of anatomy.Anatomic features of the perforator of basilar artery were observed and recorded.(3)Numbers and diameters of perforators in the vertebral artery angiography with DSA and microsurgical anatomy were contrastively analyzed;(4)All kinds of intracranial endovascular stents'diameter of wires and interlace points were retrospectively analyzed and compared with perforators' diameter.Results:(1)Compared with the two groups after angiography,we found that the average number of perforators of P1 segment is 2.00±1.01 and 1.95±1.10 on left and right side in experimental group versus to 1.52±1.71 and 1.45±0.81 in the control group;1.45±0.99 and1.43±1.15 versus to 0.78±0.65 and 0.55±0.55 in P2 segment;1.87±0.88 and 1.80±1.07versus to 0.37±0.54and 0.28±0.50 in both sides of the pons perforators artery of basilar artery.Each part perforators of the control group was less than the experimental group,the difference had statistical significance(P<0.05).(2)DSA angiography of basilar artery showed left and right long circumflex artery of the brainstem feeding artery respectively 0.54±0.51 and 0.61 ±0.50 and microanatomical result of left and right respectively 1.77±0.83 and 1.61 ±0.51;Angiography showed that the left and right short circumflex arteries were respective 1.23±0.73 and 0.84±0.80 branches.with microanatomic result of 2.54±0.66 and 2.92±0.86 left and right side respective;the respective left and right paramedian arteries were 0.85±0.80 and 0.92±0.64 branches in DSA,but 2.54±0.88 and 2.62±0.87 respective in microanatomical;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.Each part perforators of the DSA group was less than the microanatomical group,the difference had statistical significance(P<0.05);(3)The wire diameter of intracranial endovascular stents is about 50um,the interlace points' diameter of each kind of stent is less than 100um,,all the diameter of wire and interlace points is far less than the perforators artery diameter.Conclusion:(1)optimized vertebral artery angiography method can effectively show the numbers and direction of perforators of posterior circulation during doing encephalon angiography examination,which can guide neurointervention surgery and prevent to damage the related perforators in neurointervention.(2)The method of showing perforators with optimized vertebral artery angiography is a bit poor in microscopic anatomical observation,but it also can effectively show related perforators artery.lt is helpful to understand the intracranial complication of infarction via understanding the value of these perforators;(3)The diameter of wire and interlace points does not directly cause occlusion during intracranial endovascular implantation. |
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