金属裸支架与药物洗脱支架在治疗症状性椎-基底动脉狭窄与急性闭塞中的应用

Preliminary clinical application of bare metal stent and drug eluting stent angioplasty in vertebrobasilar stenosis and acute occlusion

目的评价金属裸支架(bare metal stent,BMS)与药物洗脱支架(drug eluting stent,DES)治疗症状性椎-基底动脉狭窄与急性闭塞的安全性、有效性和中短期疗效并作初步比较。方法对2005年3月至2008年1月收治的25例症状性椎-基底动脉狭窄与急性闭塞患者行血管内球囊支架成形治疗。结果25例患者成功植入28枚球囊支架,其中BMS15枚,DES13枚。植入椎动脉支架25枚,基底动脉支架3枚(其中2枚为基底动脉急性闭塞经溶栓后植入)。血管平均狭窄程度从治疗前的平均81.4%(50%～95%)降低到6.3%(0%～15%)。22例经2～36个月临床随访,平均随访23个月,3例失访。1例患者植入1枚BMS后9个月症状复发,DSA复查发现支架再狭窄达50%,患者拒绝继续治疗;1例患者植入1枚DES后35d出现急性血栓闭塞,经急诊再植入1枚DES后血管开通良好。余20例超声复查支架通畅,未见明确狭窄,未见卒中及脑缺血发作。随访22例中19例(86.4%)症状明显缓解或消失,3例(13.6%)部分缓解。结论BMS与DES治疗症状性椎-基底动脉狭窄安全、有效,中短期效果令人满意。DES降低手术后支架内再狭窄发生率具有一定的预防作用,优于BMS金属裸支架。

Objective To evaluate the clinical effects and safety of the medium short term efficacy with preliminary comparison of bare metal stent （BMS） and drug eluting stent （DES） angioplasty in vertebrobasilar stenosis and acute occlusion. Methods From March 2005 to January 2008, 25 cases of symptomatic vertebrobasilar stenosis and acute occlusion were treated by intraluminal balloon-expandable coronary stents placement and angioplasty. Results Twenty eight balloon-expandable coronary stents（BMS 15, DES 13） were placed successfully in all 25 patients, technical success was achieved in all patients （100%）. The average stenosis rate reduced from 81.4% （50% - 95%） before treatment to 6.3% （0% - 15%） after stent-assisted angioplasty. Twenty two patients had 2 to 31 months follow-up with an average of 23 months and another 3 were out of follow-up. One case occurred with restenosis after the procedure 9 months later and another case with acute thrombotic occlusion 35 days later, was restented with DES outcoming of good vascular recanalization. No TIA and stroke occured in other cases. The clinical symptoms were improved significantly or disappeared in 19 patients （86.4%） after the procedure, partial recuperation in 3. Conclusions BMS and DES stent-angioplasty in vertebrobasilar stenosis and acute occlusion is safe and effective with considerable good middle-term and short-term efficacies. DES is superial to BMS in regard to the decrease of intra-stent restenosis rate presenting a definite prevention. The addition of anti-platelet therapy may further raise the efficacy of DES.