颅内椎基底动脉狭窄支架成形术后的远期疗效

Long-term Outcome of Elective Stenting for Symptomatic Intracranial Vertebrobasilar Stenosis

目的探讨症状性动脉粥样硬化性颅内椎基底动脉狭窄患者择期支架成形术治疗的远期疗效。方法回顾性分析2001年9月至2007年9月在我院行择期支架成形术治疗的症状性动脉粥样硬化性颅内椎基底动脉狭窄(狭窄>50%)患者116例,其中基底动脉狭窄患者57例,狭窄57处;颅内椎动脉狭窄患者59例,狭窄60处。研究的主要终点事件是靶病变相关的缺血性卒中、症状性脑实质出血和蛛网膜下腔出血。结果本组病例支架手术成功率为94%(110/117)。30d内的卒中事件8例,30d后(中位时间33.5个月)椎基底动脉供血区的卒中事件5例。椎基底动脉供血区年卒中率(包括30d内的任何死亡和卒中)4.0%。结论择期支架成形术治疗可减少症状性动脉粥样硬化性颅内椎基底动脉狭窄患者的年卒中风险、改善功能预后,效果优于药物治疗。远期疗效与支架是否成功置放以及狭窄部位有关。

Objective To examine long-term outcome of a largest case series to date after elective stenting of symptomatic atherosclerotic intracranial vertebrobasilar artery(VBA) stenosis. Methods During September 2001 till September 2007, elective stenting with a balloon-expandable stent was performed in 116 consecutive patients with atherosclerotic intracranial vertebrobasilar artery(VBA) stenosis ≥50% that resulted in qualifying stroke or TIA(Transient Ischemic Attack) event within 180 days. Results There were eight strokes within 30 days, and fi ve strokes in the VBA territory after 30 days (mean of 1005 days). The annual stroke rate in the VBA territory (including any stroke and death within 30 days) was 4.0%. Signifi cantly higher stroke-free survivals in the vertebrobasilar territory were found in stent success subgroup and VA stenosis patients. Conclusion Elective stenting can reduce the annual stroke risk and improve function outcome of patients with symptomatic atherosclerotic vertebrobasilar stenosis that compares favorably to medical therapy. The long-term outcome is associated with successful stent placement and stenotic site.