Научно-практический журнал
«Клиническая физиология кровообращения»

Главный редактор

Лео Антонович Бокерия, доктор медицинских наук, профессор, академик РАН и РАМН, президент ФГБУ «НМИЦ ССХ им. А.Н. Бакулева» МЗ РФ


Ишемический инсульт в вертебробазилярном бассейне

Авторы: Бокерия Л.А., Абдулгасанов Р.А., Шогенов М.А., Султанова А.Е.

Организация:
ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» Минздрава России, Москва, Российская Федерация

Для корреспонденции: Сведения доступны для зарегистрированных пользователей.

Раздел: Обзоры

DOI: https://doi.org/10.24022/1814-6910-2022-19-1-33-46

УДК: 616.831-005.4-036.11

Библиографическая ссылка: Клиническая физиология кровообращения. 2022; 1 (19): 33-46

Цитировать как: Бокерия Л.А., Абдулгасанов Р.А., Шогенов М.А., Султанова А.Е. . Ишемический инсульт в вертебробазилярном бассейне. Клиническая физиология кровообращения. 2022; 1 (19): 33-46. DOI: 10.24022/1814-6910-2022-19-1-33-46

Ключевые слова: ишемический инсульт, вертебробазилярный бассейн, позвоночные артерии

Поступила / Принята к печати:  22.07.2021 / 25.01.2022

Полнотекстовая версия:
Оформить подписку 🔒

Аннотация

Инсульты в вертебробазилярном бассейне составляют 20–25% всех ишемических инсультов. Транзиторные ишемические атаки в вертебробазилярном бассейне могут включать кратковременные или незначительные симптомы поражения ствола головного мозга, и диагностировать их труднее, чем ишемические события в каротидном бассейне. Введение внутривенного тканевого активатора плазминогена благоприятно действует при инсульте вертебробазилярного бассейна по сравнению с инсультом в каротидном бассейне. Риск повторного инсульта в вертебробазилярном бассейне так же высок, как и при инсульте в каротидном бассейне, а вертебробазилярный стеноз увеличивает риск в 3 раза. У пациентов с гидроцефалией или повышенным внутричерепным давлением может потребоваться экстренное нейрохирургическое вмешательство. Базилярная окклюзия связана с высокой летальностью или тяжелой инвалидизацией, особенно если кровоток в сосуде не восстанавливается.

Литература

  1. Hsu C.-F., Chen K.-W., Su C.-H., Shen C.-Y., Chi H.-Y. Bilateral vertebral artery hypoplasia and fetal-type variants of the posterior cerebral artery in acute ischemic stroke. Front. Neurol. 2021; 12: 582149. DOI: 10.3389/fneur.2021.582149
  2. Carvalho V., Cruz V. Clinical presentation of vertebrobasilar stroke. Porto Biomed. J. 2020; 5: e096. DOI: 10.1097/j.pbj.0000000000000096 3. Baik S.H., Jung C., Kim B.M., Kim D.J. Mechanical thrombectomy for tandem vertebrobasilar stroke: characteristics and treatment outcome. Stroke. 2020; 51 (6): 1883–5. DOI: 10.1161/STROKEAHA.120.029503
  3. Flossmann E., Rothwell P.M. Prognosis of vertebrobasilar transient ischaemic attack and minor stroke. Brain. 2003; 126: 1940–54. DOI: 10.1093/brain/awg197
  4. Kuruvilla A., Bhattacharya P., Rajamani K., Chaturvedi S. Factors associated with misdiagnosis of acute stroke in young adults. J. Stroke Cerebrovasc. Dis. 2011; 20: 523–7. DOI: 10.1016/j.jstrokecerebrovasdis.2010.03.005
  5. Dewey H.M., Sturm J., Donnan G.A., Macdonell R.A., McNeil J.J., North East Melbourne Stroke Incidence Study. Incidence and outcome of subtypes of ischaemic stroke: initial results from the North East Melbourne Stroke Incidence Study (NEMESIS). Cerebrovasc. Dis. 2003; 15: 133–9. DOI: 10.1159/000067142
  6. Paul N.L., Simoni M. Oxford Vascular Study. Transient isolated brainstem symptoms preceding posterior circulation stroke: a population-based study. Lancet Neurol. 2013; 12: 65–71. DOI: 10.1016/s1474-4422(12)70299-5
  7. Gulli G., Markus H.S. The use of FAST and ABCD2 scores in posterior circulation, compared with anterior circulation, stroke and transient ischemic attack. J. Neurol. Neurosurg. Psychiatry. 2012; 83: 228–9. DOI: 10.1136/jnnp.2010.222091
  8. Gulli G., Marquardt L., Rothwell P.M., Markus H.S. Stroke risk after posterior circulation stroke/transient ischemic attack and its relationship to site of vertebrobasilar stenosis: pooled data analysis from prospective studies. Stroke. 2013; 44: 598–604. DOI: 10.1161/strokeaha.112.669929
  9. Tao W.D., Liu M., Fisher M., Wang D.R., Li J., Furie K.L. et al. Posterior versus anterior circulation infarction: how different are the neurological deficits? Stroke. 2012; 43: 2060–5. DOI: 10.1161/strokeaha.112.652420
  10. Oppenheim C., Stanescu R., Dormont D., Crozier S., Marro B. False-negative diffusion-weighted MR findings in acute ischemic stroke. Am. J. Neuroradiol. 2000; 21: 1434–40. 12. Merwick Á., Albers G.W., Arsava E.M., Ay H. Reduction in early stroke risk in carotid stenosis with transient ischemic attack associated with statin treatment. Stroke. 2013; 44: 2814–20. DOI: 10.1161/strokeaha.113.001576
  11. Flossmann E., Redgrave J.N. Reliability of clinical diagnosis of the symptomatic vascular territory in patients with recent transient ischemic attack or minor stroke. Stroke. 2008; 39: 2457–60. DOI: 10.1161/strokeaha.107.511428
  12. Savitz S.I., Caplan L.R. Vertebrobasilar disease. N. Engl. J. Med. 2005; 352: 2618. DOI: 10.1056/nejmra041544
  13. Caplan L.R., Wityk R.J., Glass T.A., Tapia J., Pazdera L., Chang H.M. et al. New England Medical Center posterior circulation registry. Ann. Neurol. 2004; 56: 389. DOI: 10.1002/ana.20204
  14. Gulli G., Khan S., Markus H.S. Vertebrobasilar stenosis predicts high early recurrent stroke risk in posterior circulation stroke and TIA. Stroke. 2009; 40: 2732–7. DOI: 10.1161/strokeaha.109.553859
  15. Marquardt L., Kuker W., Chandratheva A. Incidence and prognosis of ≥50% symptomatic vertebral or basilar artery stenosis: prospective population-based study. Brain. 2009; 132: 982–8. DOI: 10.1093/brain/awp026
  16. Schievink W. Spontaneous dissection of the carotid and vertebral arteries. N. Engl. J. Med. 2001; 344: 898–906. DOI: 10.1056/nejm200103223441206
  17. Lou M., Caplan L.R. Vertebrobasilar dilatative arteriopathy (dolichoectasia). Ann. N. Y. Acad. Sci. 2010; 1184: 121–33. DOI: 10.1111/j.1749-6632.2009.05114.x
  18. A classification and outline of cerebrovascular diseases II. Stroke. 1975; 6: 564–616. DOI: 10.1161/01.str. 6.5.564
  19. Searls D.E., Pazdera L., Korbel E., Vysata O. Symptoms and signs of posterior circulation ischemia in the New England Medical Center posterior circulation registry. Arch. Neurol. 2012; 69: 346. DOI: 10.1001/archneurol.2011.2083
  20. Kattah J.C., Talkad A.V., Wang D.Z., Hsieh Y.H., Newman-Toker D.E. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009; 40: 3504–10. DOI: 10.1161/strokeaha.109.551234
  21. Caplan L. Posterior circulation ischemia: then, now, and tomorrow. Stroke. 2000; 31: 2011–23. DOI: 10.1161/01.str.31.8.2011
  22. Von Campe G., Regli F., Bogousslavsky J. Heralding manifestations of basilar artery occlusion with lethal or severe stroke. J. Neurol. Neurosurg. Psychiatry. 2003; 74: 1621–6. DOI: 10.1136/jnnp.74.12.1621
  23. attle H.P., Arnold M., Lindsberg P.J. Basilar artery occlusion. Lancet Neurol. 2011; 10: 1002–14. DOI: 10.1016/s1474-4422(11)70229-0
  24. Bogousslavsky J., Van Melle G., Regli F. The Lausanne stroke registry: analysis of 1000 consecutive patients with first stroke. Stroke. 1988; 19: 1083–92. DOI: 10.1161/01.str.19.9.1083
  25. Hatano S. Experience from a multicentre stroke register: a preliminary report. Bull. World Health Organ. 1976; 54: 541–53.
  26. Nor A.M., Davis J., Sen B. The recognition of stroke in the emergency room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurol. 2005; 4: 727–34. DOI: 10.1016/s1474-4422(05)70201-5
  27. Bash S., Villablanca J.P., Jahan R., Duckwiler G., Tillis M., Kidwell C. et al. Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography. Am. J. Neuroradiol. 2005; 26: 1012–21.
  28. Chalela J.A., Kidwell C.S., Nentwich L.M., Luby M., Butman J.A., Demchuk A.M. et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007; 369: 293–8. DOI: 10.1016/s0140-6736(07)60151-2
  29. Edlow J.A., Newman-Toker D.E., Savitz S.I. Diagnosis and initial management of cerebellar infarction. Lancet Neurol. 2008; 7: 951–64. DOI: 10.1016/s1474-4422 (08)70216-3
  30. Easton J.D., Saver J.L., Albers G.W., Alberts M.J. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Stroke. 2009; 40: 2276–93. DOI: 10.1161/strokeaha.108.192218
  31. Merwick A., Albers G.W., Amarenco P., Arsava E.M., Ay H., Calvet D. et al. Addition of brain and carotid imaging to the ABCD2 score to improve identification of patients at high early stroke risk after transient ischaemic attack. Lancet Neurol. 2010; 9: 1060–9. DOI: 10.1016/s1474-4422(10)70240-4
  32. Moreau F., Modi J., Almekhlafi M., Bal S., Goyal M., Hill M.D. et al. Early magnetic resonance imaging in transient ischemic attack and minor stroke: do it or lose it. Stroke. 2013; 44: 671–4. DOI: 10.1161/strokeaha.111.680033
  33. Hacke W., Kaste M., Bluhmki E., Brozman M., Dávalos A., Guidetti D. et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N. Engl. J. Med. 2008; 359: 1317–29. DOI: 10.1056/nejmoa0804656
  34. Förster A., Gass A., Kern R., Griebe M. Thrombolysis in posterior circulation stroke: stroke subtypes and patterns, complications and outcome. Cerebrovasc. Dis. 2011; 32: 349–53. DOI: 10.1159/000330346
  35. Sarraj A., Medrek S., Albright K., Martin-Schild S., Bibars W. Posterior circulation stroke is associated with prolonged door-to-needle time. Int. J. Stroke. 2013. DOI: 10.1111/j.1747-4949-2012.00952.х
  36. Schonewille W.J., Wijman C.A., Michel P., Rueckert C.M., Weimar C., Mattle H.P. et al. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurol. 2009; 8: 724–30. DOI: 10.1016/s1474-4422(09)70173-5
  37. Lutsep H.L., Rymer M.M., Nesbit G.M. Vertebrobasilar revascularization rates and outcomes in the MERCI and multi-MERCI trials. J. Stroke Cerebrovasc. Dis. 2008; 17: 55–7. DOI: 10.1016/j.jstrokecerebrovasdis.2007.11.003
  38. Hacke W., Zeumer H., Ferbert A., Bruckmann H. Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke. 1988; 19: 1216–22. DOI: 10.1161/01.str.19.10.1216
  39. Levy E.I., Siddiqui A.H., Crumlish A., Snyder K.V., Hauck E.F., Fiorella D.J. et al. First food and drug administration-approved prospective trial of primary intracranial stenting for acute stroke: SARIS (stentassisted recanalization in acute ischemic stroke). Stroke. 2009; 40: 3552–6. DOI: 10.1161/strokeaha.109.561274
  40. Lindsberg P.J., Mattle H.P. Therapy of basilar artery occlusion: a systematic analysis comparing intra-arterial and intravenous thrombolysis. Stroke. 2006; 37: 922–8. DOI: 10.1161/01.str.0000202582.29510.6b
  41. Strbian D., Sairanen T., Silvennoinen H., Salonen O., Kaste M., Lindsberg P.J. Thrombolysis of basilar artery occlusion: impact of baseline ischemia and time. Ann. Neurol. 2013; 73: 688–94. DOI: 10.1002/ana.23904
  42. Horwitz N.H., Ludolph C. Acute obstructive hydrocephalus caused by cerebellar infarction: treatment alternatives. Surg. Neurol. 1983; 20: 13–9. DOI: 10.1016/0090-3019(83)90099-x
  43. Hornig C.R., Rust D.S., Busse O., Jauss M., Laun A. Space-occupying cerebellar infarction: clinical course and prognosis. Stroke. 1994; 25: 372–4. DOI: 10.1161/01.str.25.2.372
  44. Jauch E.C., Saver J.L., Adams H.P. Jr, Bruno A., Connors J.J., Demaerschalk B.M. et al.; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013; 44: 870–947. DOI: 10.1161/str.0b013e318284056a
  45. Intercollegiate Stroke Working Party. National clinical guideline for stroke. 4th ed. Royal College of Physicians; 2012. Available at: http://www.rcplondon.ac.uk/sites/default/files/national-clinical-guidelinesfor-stroke-fourth-edition.pdf (accessed 16.09.2021)
  46. Cotter P.E., Martin P.J., Ring L., Warburton E.A., Belham M., Pugh P.J. Incidence of atrial fibrillation detected by implantable loop recorders in unexplained stroke. Neurology. 2013; 80: 1546–50. DOI: 10.1212/wnl.0b013e31828f1828
  47. Wang Y., WangY., Zhao X., Liu L., Wang D., Wang C. et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N. Engl. J. Med. 2013; 369: 11–9.
  48. Amarenco P., Bogousslavsky J., Callahan A. III, Goldstein L.B., Hennerici M., Rudolph A.E. et al.; Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators. High-dose atorvastatin after stroke or transient ischemic attack. N. Engl. J. Med. 2006; 355: 549–59. DOI: 10.1056/nejmoa061894
  49. PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001; 358: 1033–41. DOI: 10.1016/s0140-6736(01)06178-5
  50. Lindsberg P.J., Soinne L., Tatlisumak T., Roine R.O., Kallela M., Häppölä O. et al. Long-term outcome after intravenous thrombolysis of basilar artery occlusion. JAMA. 2004; 292: 1862–6. DOI: 10.1001/jama.292.15.1862
  51. St. George’s, University of London. Vertebral artery ischaemia stenting trial (VIST). Available at: http://www.vist.sgul.ac.uk (accessed 16.09.2021)
  52. Compter A., van der Worp H.B., Schonewille W.J., Vos J.A., Algra A., Lo T.H. et al. VAST: vertebral artery stenting trial. Protocol for a randomised safety and feasibility trial. Trials. 2008; 9: 65. DOI: 10.1186/1745- 6215-9-65
  53. Johnston S.C., Rothwell P.M., Nguyen-Huynh M.N., Giles M.F., Elkins J.S., Bernstein A.L. et al. Validation and refinement of scores to predict very early stroke after transient ischaemic attack. Lancet. 2007; 369: 283–92. DOI: 10.1016/s0140-6736(07)60150-0
  54. Sheehan O.C., Merwick A., Kelly L.A., Hannon N., Marnane M., Kyne L. et al. Diagnostic usefulness of ABCD2 score to distinguish TIA and minor ischemic stroke from non-cerebrovascular events: the North Dublin TIA study. Stroke. 2009; 40: 3449–54. DOI: 10.1161/strokeaha.109.557074

Об авторах

  • Бокерия Лео Антонович, д-р мед. наук, профессор, академик РАН и РАМН, президент; ORCID
  • Абдулгасанов Рамиз Алиевич, д-р мед. наук, гл. науч. сотр.; ORCID
  • Шогенов Мухамед Асланович, врач – сердечно-сосудистый хирург; ORCID
  • Султанова Аида Ельхановна, клинический ординатор; ORCID

 Если вы заметили опечатку, выделите текст и нажмите Alt+A