经皮单一支架治疗椎动脉、锁骨下动脉分叉部串联狭窄

Percutaneous single-stent endovascular treatment of series stenosis at subclavian-vertebral artery bifurcation

目的初步评价经皮单一支架治疗椎动脉、锁骨下动脉分叉部串联狭窄的疗效及安全性。方法 2009年2月至2010年4月对7例椎动脉、锁骨下动脉分叉部串联狭窄患者,在置入脑保护装置下进行了经皮单一支架治疗椎动脉、锁骨下动脉分叉部2处狭窄。所有患者均作定期随访,以临床症状、多普勒超声评估治疗效果并观察有无再狭窄。结果本组7例患者即时成功率100%,椎动脉和锁骨下动脉残余狭窄均小于10%,无手术相关并发症,3～15个月的临床随访,多普勒超声检查未发现再狭窄,患者临床症状明显改善,无脑缺血发作及新发脑梗死。结论经皮单一支架治疗椎动脉、锁骨下动脉分叉部串联狭窄技术上是可行的,与其他技术相比,可操作性强,安全性高,远期疗效有待于进一步观察。

Objective To evaluate the efficacy and safety of percutaneous endovascular management with single stent in treating symptomatic series stenosis located at subclavian-vertebral artery bifurcation.Methods Between February 2009 and April 2010,percutaneous single-stent endovascular treatment was carried out in 7 consecutive patients with symptomatic series stenosis located at subclavian-vertebral artery bifurcation.After implantation of cerebral protection device,percutaneous single-stent endovascular procedure was performed to treat two stenoses at subclavian-vertebral artery bifurcation.All patients were followed up for 3 ～ 15 months.The therapeutic efficacy was evaluated with the observation of clinical symptoms and Doppler ultrasonic examination,the possible occurrence of re-stenosis was checked.Results Technical success was achieved in all seven patients.After the implantation the residual stenosis of both subclavian and vertebral arteries was less than 10%.No procedure-related complications occurred.During the follow-up period no re-stenosis was observed on Doppler ultrasonograph,the clinical symptoms were markedly improved,and no cerebrovascular accident or new cerebral infarction occurred.Conclusion For the treatment of series stenosis located at subclavian-vertebral artery bifurcation percutaneous single-stent endovascular implantation is a feasible technique.Compared with other methods,this technique carries the advantages of easier manipulation and higher safety for patient although long-term efficacy needs to be further observed.