药物洗脱支架在后循环动脉狭窄治疗中的应用

The utility of drug-eluting stent in the treatment of posterior circulation artery stenosis

目的研究在后循环动脉狭窄治疗中应用药物洗脱支架的安全性和疗效性。方法经常规造影证实椎动脉狭窄者30例,接受支架置入治疗者19例。局麻或全麻下经右股动脉以Seldinger技术置入6F导管鞘,在相应导丝辅助下使导引导管进入锁骨下动脉或椎动脉,血管造影后沿导引导管插入0.014英寸、300cm或205cm导丝至狭窄远端,经此微导丝交换置入相应规格球囊扩张式CypherTM支架(10例)或TAXUSTM支架(9例)。结果19例患者手术均成功,无死亡和并发症,置入支架贴壁良好,血流明显改善,狭窄远端分支血管(小脑后下动脉等)充盈明显改善,狭窄率由原来的平均87.5%降至平均5.2%。15例表现为眩晕症状的患者术后症状消失12例(80%),改善3例。表现为共济失调的6例患者术后共济运动基本正常4例,明显改善2例,表现为小脑性语言障碍的1例患者术后明显改善。完成至少1次造影随访的患者15例,经DSA证实无再狭窄发生。所有患者门诊随访,最长18个月。结论药物洗脱支架在后循环动脉狭窄的治疗中安全、有效,在短期内能防止术后再狭窄,长期疗效需进一步观察,需要大样本的随机对照研究进一步证实。

Objective To evaluate the safety and efficacy of drug-eluting stent in the treatment of posterior circulation artery stenosis. Methods 19 patients （19/30）with extra or intracranial vertebral artery stenosis diagnosed by angiography received drug-eluting stent place ment after anticoagulation therapy. The Seldinger technique was used to insert the 6 F sheath into the right femoral artery under local or general anesthesia. After set up of guide wire the 6 F guiding catheter was introduced into the subclavian artery at the origination point of vertebral artery and then the micro-guide-wire of 0.014in, 300 cm or 205 cm reached at the distal part of stenosis through the guiding catheter. The correlated balloon expandable stent Cypher^TM or TAXUS^TM was successfully deployed and postdilation was performed if necessary. Results All the procedures were succeeded without mortality and any complications. The stents showed good coherence to the vessels＇ wall without any separation and the blood flow improved greatly as the distal branch arteries completely opacified by angiography. The proportion of stenosis decreased from 87.5% to 5.2%. The vertigo disappeared in twelve cases （12/15） and improved in three cases （3/15）. 6 patients with manifestation of ataxia, recovered to normal in 4 and the other two improved obviously. One patient with cerebella dysphasia improved conspicuously after stenting. No less than 15 cases were followed up by secondary angiography and others were followed up clinically. Conclusions The preliminary application of drog-eluting stent in the treatment of posterior circulation artery stenosis seems to be safety and efficient with prevention of the arterial from restenosis. However, further large scale and randomized study should be carried out in need.（J Intervent Radiol, 2007,16. 439-442）