经皮血管内球囊成形支架置入术治疗症状性椎动脉狭窄

Percutaneous transluminal bolloon angioplasty and stenting for treatment of patients with symptomatic vertebral artery stenosis

目的探讨经皮血管内球囊成形支架置入术治疗症状性椎动脉狭窄的适应症、疗效及安全性。方法应用血管内支架成形术对14例经内科药物治疗无效的椎动脉狭窄患者进行治疗,其中13例为后循环缺血,1例为前循环缺血卒中,但通过后循环侧枝代偿;脑数字减影血管造影(DSA)检查显示椎动脉V1段狭窄7例,V3～V4段结合部狭窄2例,V4段狭窄5例,狭窄率在50～69%4例、70～89%10例。结果支架置入后即刻行脑DSA,影像学所见8例狭窄血管管径恢复正常,4例血管残余狭窄<10%,2例血管残余狭窄<20%;术后采用Malek评定法评分,30d时14例均为1分;3个月时随访9例均为1分;1年时随访6例,1分5例,2分1例。结论经皮血管内球囊成形支架置入术治疗症状性椎动脉狭窄是一种安全有效的微创手术。

Objective To explore the indications, safety and efficacy of percutaneous transluminal bolloon angioplasty and stenting in patieuts with symptomatic vertebral artery stenosis. Methods The transluminal stent-assisted angioplasty was performed in 14 patients with symptomatic vertebral artery stenosis, whose medical therapy had failed. Among of them, 13 patients were subjected to posterior-circulation isehemia, while one patient had anterior-circulation stroke, whose middle cerebral artery was compensated by ipsilateral posterior communicating artery. Digital subtraction angiography before treatment demonstrated that the vertebral artery stenosis located at V1 segment in 7 patients, V3-V4 conjugate segment in 2 patients,and V4 segment in 5 patients. The degree of stenosis was 50-69% in 4 patients, and 70-89% in 10 patients. Results Poststenting angiography revealed complete restoration of the vessel lumen in 8 patients, 〈1 0% residual stenosis in 4 patients,and 〈20% residual stenosis in 2 patients. After the procedure, neurological outcome was determined according to Maleks score. At the time of 30 days,all the patients got 1 score. At 12 months of followup, five of 6 patients got 1 score and one got 2 score. Conclusion Percutaneous transluminal bolloon angioplasty and stenting is a minimally invasive technique of safety and efficacy for treatment of symptomatic vertebral artery stenosis. However,its long-term results need further investigation.