作者：陈晓琴1，童薪宇2，董佳3，4，梅玉倩5，6，刘倩6，刘月1，陈广新1

单位：

1.157011黑龙江省牡丹江市，牡丹江医学院医学影像学院　2.100081北京市，北京理工大学生命学院　3.100053北京市，首都医科大学宣武医院介入放射科　4.100053北京市，首都医科大学宣武医院神经外科　5.637100四川省南充市，川北医学院医学影像学院　6.157011黑龙江省牡丹江市，牡丹江医学院生命科学学院

Units：

1.Medical Image College, Mudanjiang Medical University, Mudanjiang 157011, China2.School of Life Science, Beijing Institute of Technology, Beijing 100081, China3.Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China4.Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China5.School of Medical Imaging, North Sichuan Medical College, Nanchong 637100, China6.College of Life Science, Mudanjiang Medical University, Mudanjiang 157011, China

关键词：

缺血性卒中；后循环脑梗塞；椎基底动脉开窗；综述

Keywords：

Ischemic stroke; Posterior circulation brain infarction; Vertebrobasilar artery fenestration; Review

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.206

Funds：

国家自然科学基金青年科学基金项目（82001938）；川北医学院博士启动基金项目（CBY21-QD03）

摘要：

椎基底动脉段是大脑后循环血液的主要供应系统，同时也是颅内动脉开窗的好发处，当该段血管发生异常解剖变异时会影响相关脑组织血液供应。目前医学影像技术的发展使椎基底动脉开窗检出率增加，且越来越多研究证明椎基底动脉开窗与脑内其他血管异常疾病相关。全面了解椎基底动脉开窗结构有助于后循环缺血性卒中患者手术方案的制定，极大地提高手术成功率。但目前椎基底动脉开窗相关研究较少，多以个案报道为主，尚未阐明椎基底动脉开窗与后循环缺血性卒中的关系，故仍需要进一步研究探索。本文从动脉开窗的分类、椎基底动脉开窗处的血流动力学变化、椎基底动脉开窗与后循环缺血性卒中的关系及伴有椎基底动脉开窗的后循环缺血性卒中患者的临床治疗4个方面进行阐述，指出椎基底动脉开窗的病理机制为原始胚胎血管融合失败或血管网络不完全吻合造成椎基底动脉管腔由单腔分裂为双腔，推测椎基底动脉开窗导致后循环缺血性卒中的机制主要是椎基底动脉血流动力学及血管壁结构的异常改变形成了分流器作用，同时开窗本身结构表现为内侧膜部分丢失、开窗附近弹性蛋白不连续，导致开窗处正常层状血流被破坏，产生涡流、二次流及高壁面压力等，引起生物活性因子分泌紊乱，并促进斑块形成成分（如单核细胞和脂蛋白）沉积于管壁，易造成血栓形成并进一步损伤动脉管壁，形成恶性循环，最终血栓脱落并随血液循环进入椎基底动脉供应区域，进而导致后循环缺血性卒中。因此，在伴有椎基底动脉开窗的后循环缺血性卒中患者的治疗过程中，应着重观察开窗血管及毗邻血管网结构并制定合适的血管内介入治疗策略。

Abstract：

Vertebrobasilar artery segment is the main supply system of posterior cerebral circulation blood, whereis also a predilection site for intracranial artery fenestration. When abnormal anatomical variations occur in this segment ofblood vessels, it will affect the blood supply of related brain tissues. At present, the detection rate of vertebrobasilar arteryfenestration has increased due to the development of medical imaging technology, and more and more studies have demonstratedthat vertebrobasilar artery fenestration is associated with other vascular abnormalities. A comprehensive understanding ofvertebrobasilar artery fenestration structure is helpful for the development of surgical plans for patients with posterior circulationischemic stroke and greatly improves the success rate of surgery. However, there are few studies related to vertebrobasilar arteryfenestration, mostly single case reports, and the relationship between vertebrobasilar artery fenestration and posterior circulationischemic stroke has not been elucidated, so further studies are still needed to explore. In this paper, the classification of arteryfenestration, hemodynamic changes at vertebrobasilar artery fenestration, the relationship between vertebrobasilar arteryfenestration and posterior circulation ischemic stroke, and the clinical treatment of posterior circulation ischemic stroke patientswith vertebrobasilar artery fenestration are described. It is pointed out that the pathological mechanism of vertebrobasilar arteryfenestration is that the vertebrobasilar artery lumen is divided from single lumen to double lumen due to the failure of primitiveembryonic vascular fusion or incomplete anastomosis of vascular network. It is speculated that the mechanism of vertebrobasilarartery fenestration leading to posterior circulation ischemic stroke is mainly due to the abnormal changes of vertebrobasilarartery hemodynamics and vascular wall structure forming the shunt effect. At the same time, the structure of fenestration itselfis manifested as partial loss of medial membrane and discontinuous elastin near the fenestration, resulting in the destructionof normal laminar blood flow at the fenestration, eddy flow, secondary flow and high wall pressure, resulting in the secretion ofbioactive factors, and promoting the deposition of plaque forming components (such as monocytes and lipoproteins) in the wall.It is easy to cause thrombosis and further damage the arterial wall, forming a vicious circle, and finally the thrombus falls off andenters the vertebrobasilar artery supply area with the blood circulation, thereby leading to posterior circulation ischemic stroke.Therefore, in the treatment of posterior circulation ischemic stroke patients with vertebrobasilar artery fenestration, the fenestratedvessels and adjacent vascular network structures should be observed and appropriate endovascular interventional treatmentstrategies should be formulated.

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