症状性椎基底动脉狭窄经皮腔内支架成形的初步研究

Transluminal stent-assisted angioplasty for the symptomatic vertebra-basilar arteries stenosis

目的探讨经皮腔内支架成形治疗椎基底动脉狭窄的临床疗效及适应证。方法2004年4月-2006年12月共收治22例患者：优势侧椎动脉狭窄4例；双侧椎动脉狭窄3例；一侧椎动脉狭窄、对侧椎动脉闭塞8例；单纯基底动脉狭窄5例；优势或“孤立”椎动脉狭窄合并基底动脉串联病变2例。治疗的24处病变：椎动脉开口8例，V4段椎动脉9例，基底动脉7例；Mori A型病变16例，B型病变8例。结果22例患者技术成功率95％，术前平均狭窄率为78．3％，术后残余狭窄率平均15％（P〈0．01）。除1例基底动脉支架成形致血管破裂出血死亡，余病例在围手术期内未发生严重并发症。17例患者随访1～24个月（平均13．5个月），Malek评分为1分者12例，2分者4例，3分者1例。结论症状性椎基动脉狭窄支架成形术疗效确切，但手术的难度和风险仍较大，临床就其适应证和长期疗效需要进一步积累经验。

Objective To evaluate the clinical effectivity and applicability of translumianl stent-assisted angioplasty for the symptomatic vertebral-basilar arteries stenosis. Methods During the period from April 2004 to August 2006, 22 patients with symptomatic vertebral-basilar arteries stenosis were treated with balloon-expanded stents. Unilateral significant stenosis of the dominant vertebral artery was found in four cases, the vertebral artery stenosis with controlateral stenosis in three ones, the vertebral artery stenosis with controlateral occlusion in eight ones, purely basilar artery stenosis in five ones, dominant or unilateral vertebral artery stenosis and basiler artery stenosis in two ones. The locations of stenosis were original vertebral artery in 8, V4 vertebral artery in 9, basilar artery in 7. The modalities of stenosis were Mori A type in 16 ones and Mori B type in 8 ones. Results Twenty one patients were successfully treated with stent-assisted angioplasty and suffered no major complications. One basilar artery rupture happened with death. The successful rate of stent implantation was ninty five percent in all 22 patients. The degree of stenosis was improved from 78.3% before angioplasty to 15 after stent implantation （P〈0.01）. Seventeen patients were followed up and evaluated by Maled Grade within the period ranged from 1 month to 24 months （mean 13.5 months）. Grade one in 12 ones, two in 4 ones and three in one. Conclusion Preliminary results suggest that it is effective to perform transluminal stent-assisted angioplasty for the symptomatic vertebra-basilar arteries stenosis, and the procedure is at great risk and difficulty. We should pay more attention to its clinical applicability and long-term curative effect.