椎动脉开口部狭窄的支架成形术及长期随访

Stent-assisted angioplasty and long-term results in atherosclerotic vertebral artery ostial stenosis

目的评价椎动脉开口狭窄的支架成形手术的安全性、可行性和远期疗效。方法 41例(48处病变)椎动脉开口狭窄(狭窄率≥50%)患者接受了支架成形术治疗。结果男37例,女4例。技术成功率为97.9%,1例术后发生右侧枕叶栓塞事件。术后30 d 内无1例死亡。21例(26处靶病变)进行了造影复查,9例(9处靶病变)发生支架内再狭窄(34.6%),2例为症状性再狭窄。结论此种治疗方法安全可行,能够预防病变相关供血区的卒中和死亡,有效减少后循环短暂脑缺血发作事件。

Objective To evaluate the safety, feasibility and long-term results of stent-assisted angioplasty in atherosclerotic ostial stenosis of vertebral artery （VA）. Methods Forty one patients （48 lesions） with symptomatic cerebral ischemic events or stroke attributed to VA atherosclerotic ostial stenosis ≥50% （NASCET method） found in digital subtraction angiography （DSA） were approached for consent to participate in the study. During the procedure, three cases used protection devices and three used drug- eluting stents. Results Thirty seven of the patients were male and 4 female. Mean age was 63.4 years （ range 36 - 80）. Technical success was achieved in 97.9 % of the lesions. One suffered from a stroke that occurred within 30-days postprocedural. 37 patients were followed up for 22. 4 months. The clinical follow- up outcomes showed that there were no lesion-related strokes and deaths, three appeared to have return of neurological symptoms（TIA）. Among the 21 patients （26 lesions） who had angiography follow-up, restenosis （ I〉50% ） was revealed in 9 patients （9 lesions） （34.6%）. However, seven of these 9 patients remained asymptomatic. Conclusions Stent-assisted angioplasty for atherosclerotic ostial stenosis of VA is safe and feasible. It can prevent the lesion-related stroke, death and TIA recurrence . However, further studies are needed to clarify how to reduce the relatively high re-stenosis rate.