支架成形术治疗不同Mori分型椎-基底动脉重度狭窄的研究

Therapeutic effect of stent angioplasty for severe vertebrobasilar artery stenosis of different Moritypes

目的评价对不同Mori分型的椎-基底动脉重度狭窄患者行支架成形术的疗效及早期预后。方法回顾性分析18例症状性椎-基底动脉重度狭窄患者的资料,按照Mori分型采用球囊扩张支架和自膨式支架行支架成形术,比较不同Mori分型的椎-基底动脉重度狭窄患者在支架选择、围手术期并发症及早期预后的情况。结果①按Mori分型,18例患者中Mori A型8例,MoriB型4例,Mori C型6例。②对Mori A型不和Mori B型患者均选用球囊扩张支架,Mori C型1例患者选用球囊扩张支架,5例选用Wingspan自膨式支架。支架成形术的技术成功率均为100%。③术后第2天和术后第30天复查TCD,显示支架内血流通畅,均术出现再狭窄。④除1例Mori C型患者于术后24h脑桥有少量出血之外,其余患者围手术期均末出现手术相关并发症,也未出现神经系统新发症状。⑤17例出现眩晕症状的患者中,14例术后症状消失,其中Mori A型6例,Mori B型3例,Mori C型5例。结论在支架成形术中,对Mori A型、Mori B型椎-基底动脉重度狭窄患者可选用球囊扩张支架,Mori C型患者可选用Wingspan支架。支架成形术治疗椎-基底动脉重度狭窄是安全有效的,早期预后良好,长期疗效仍需进一步观察。

Objective To evaluate the efficacy and early prognosis of stent angioplasty in patients with severe vertebrobasilar artery stenosis of different Mori types. Methods Eighteen patients with severe symptomatic vertebrobasilar artery stenosis were analyzed retrospectively. Stent angioplasty was performed with balloon-expandable stents and serf-expanded stents according to the different Mori types. Stent selection, perioperative complications and early prognosis in patients with severe vertebrobasilar artery stenosis of different Mori types were compared. Results （1）Eighteen patients were divided into type A （ n = 8 ） , B （n = 4）, and C （n = 6） according to Mori types. （2）Ballon-expandable stents were selected in patients of Mori type A and B. One patient of Mori type C selected ballon-expandable stents, and the other five patients selected Wingspan self-expandable stents. The technical success rate of stent angioplasty was 100%. （3）At 2 and 30 days after operation, TCD reexamination showed that in-stent blood flow was patent, and no restenosis was observed. （4） Except one patient of Moll type C had small amount of pontine hemorrhage, the other patients neither had perioperative surgery-related complications, nor had any new neurological symptoms. （5）Among the 17 patients who had dizziness, the symptoms disappeared in 14 patients after the procedures. Among them, 6 were in Mori type A, 3 were in type B, and 5 were in type C. Conclusion For patients with severe vertebrobasilar artery stenosis of Mori type A or B the ballon-expandable stents may be chosen, and for patients of Mori type C the Wingspan self-expandable stents may be chosen. Stent angioplasty in the treatment of severe vertehrohasilar artery stenosis is safe and effective, and its early resuh is good, however, its long-term efficacy remains to be further observed.