症状性椎基底动脉狭窄血管内支架成形术疗效观察

Study of stent-assisted angioplasty for symptomatic vertebra-basilar arteries stenosis

目的探讨血管内支架治疗椎基底动脉狭窄的安全性、有效性及与药物治疗相比的优越性。方法对我院2005-05—2010-05收治的27例椎基底动脉狭窄的患者行血管内支架植入术治疗(支架组),对同期32例椎基底动脉狭窄的患者采取单纯药物治疗(药物组),比较2组发病后3个月、6个月、12个月及1a后卒中及TIA发生率、美国国立卫生院卒中量表神经功能缺损评分(NIHSS)。结果支架组:1例因径路差而手术终止;1例术中发生蛛网膜下腔出血,最终死于脑干梗死;5例术中出现一过性头晕、恶心、呕吐,支架释放后症状迅速改善;1例出现穿刺点血肿,局部压迫处理后血肿未再扩大。随访中,1例椎动脉开口部位支架于术后6个月再次TIA发作,复查造影证实为支架内再狭窄,单纯球囊扩张治疗症状缓解;1例椎动脉V4段支架于术后2a再次出现眩晕、共济失调,造影证实为支架内再狭窄,球囊扩张后症状消失。1例手术失败者于术后18个月再次脑干梗死。药物组:发病后3个月、6个月、12个月、1a后分别有5例、7例、6例及13例卒中复发,3例1a后随访,死于脑干梗死。2组卒中、TIA复发率及神经功能评分比较,支架组均低于药物组,差异有统计学意义(P<0.05)。结论血管内支架成形术治疗症状性椎基底动脉狭窄安全、有效,与内科药物治疗相比,能更好地预防卒中复发,值得临床推广应用。

Objective To evaluate the clinical affectivity and applicability of stent-assisted angioplasty for the symptomatic vertebral-basilar arteries stenosis,and compare the effects with the medical therapy. Methods During the period from May 2005 to May 2010,27 patients with symptomatic vertebral-basilar arteries stenosis were treated with stent-assisted angioplasty.In the same time,32 similar cases were treated with medicine.Both groups were followed-up after 3 months,6 months,12 months and 1 year.The incidence of ischemic stroke or transient ischemic attack and the NIHSS scores between the two groups were compared. Results In the stent group,the operation was terminated in 1 case because of poor operation path.Subarachnoid hemorrhage occurred in 1 case and the patient finally died because of stem infarction.Five patients experienced dizziness,nausea or vomiting in the operation process but the symptoms quickly disappeared after the stent-releasing.Puncture hematoma occurred in 1 case but without expanding after local compression treatment.During the follow-up,TIA attack reoccurred in 1 case of original vertebral artery stent after 6 months because of restenosis and the symptom disappeared after balloon dilatation.One patient with V4 segment of vertebral artery stent experienced vertigo and ataxia after 2 years because of restenosis and the symptom disappeared after balloon dilatation.Brainstem infarction reoccurred in 1 case whose operation was failure after 18 months.In the medicine group,there were 5 cases,7 cases,6 cases and 13 cases of stroke or TIA attack during 3 months,6 months,12 months and over 1 year follow-up period.Three patients died after 1 year because of brainstem infarction.The NIHSS score during 3 months,6 months,12 months and over 1 year follow-up period between the two groups were compared.The score of stent group was significantly lower than that of medicine group.The results showed that the stent group was superior to the medicine group in stroke recurrence rate and stroke scores. Conclusion Intravascular stent treatment is a safe and feasible method to the patients with symptomatic vertebra-basilar artery stenosis,it is better to prevent the recurrence of stroke and is worth clinical popularizing and applocation.