血管内支架置入治疗症状性椎动脉迂曲打折狭窄的临床研究

Intravascular stent implantation in treating patients with symptomatic vertebral artery kinking

目的探讨血管内支架置入治疗症状性椎动脉迂曲打折狭窄的安全性与有效性。方法对第三军医大学大坪医院神经内科自2007年12月至2009年12月收治的36例经DSA证实为椎动脉迂曲打折狭窄并符合支架置入指征的患者实施血管内支架置入治疗，观察其对血管狭窄改善、血流动力学的影响及术后并发症，并进行1年的随访．通过Malek评分判断其临床疗效。结果36例患者均完成椎动脉迂曲打折狭窄部位的支架置入术，手术成功率为100％；血管狭窄率从术前的76％±15％下降到术后的8％±3％，椎动脉起始部迂曲打折部位平均血流速度由术前（45．4±22．3）cm／s降低到术后（31．8±15．1）cm／s，差异均有统计学意义（P〈0．05）。2例患者发生穿刺点皮下血肿，1例发生股动脉假性动脉瘤，1例发生小脑出血，但均未产生严重后果。随访1年后，Malek评定法评估36例患者的临床疗效为1分31例，2分3例，3分1例，4分1例．5分0例；随访期内86％患者无后循环缺血和神经功能缺失症状，无有意义的支架内再狭窄发生。结论血管内支架置入治疗症状性椎动脉迂曲打折狭窄安全有效。

Objective To evaluate the feasibility and safety of stent implantation in treating patients with symptomatic vertebral artery kinking. Methods Thirty-six patients with vertebral artery kinking confirmed by DSA and accorded with the stent implantation indications were chosen in our study; these patients were performed stent implantation. The stenosis and haemodynamics changes, and recent and postoperative complications were observed; Malek scale was adopted to evaluate the clinical efficacy during the 1-year follow-up. Results The success rate of stent implantation for patients with symptomatic vertebral artery kinking was 100%. The percentage of stenosis was significantly reduced from （76%±15%） to （8%±3%） after stenting （P〈0.05）; the mean flow velocity of kinking lesion was obviously decreased from （[45.4±22.3] cm/s） to （[31.8±15.1] cm/s, P〈0.05）; cerebellum hematoma was noted in I patient subcutaneous hematoma of puncture point in 2 and femoral artery pseudoaneurysms after the stenting in 1; all these complications did not cause serious consequences. Malek scale indicated that 31 patients got 1 point, 3 got 2 points, 1 got 3 points, 1 got 4 points and no one got 5 points; 31 patients were asymptomatic during the 1-year follow-up; no significant in-stent restenosis was found. Conclusion Symptomatic vertebral artery kinking can be treated safely and effectively with stent implantation.