椎-基底动脉狭窄血管内支架植入25例疗效分析

Endovascnlar stent implantation for vertebrobasilar artery stenosis:an analysis of 25 cases

目的探讨椎-基底动脉狭窄患者血管内支架植入治疗的疗效和安全性。方法 2009年3月至2010年11月收治25例椎-基底动脉狭窄患者,经DSA证实26支责任血管,临床表现为短暂性脑缺血发作7例,症状性脑卒中18例。对25例患者进行了血管成形及支架植入治疗,并于1、6、12个月随访临床症状及支架情况,了解有无再狭窄。结果支架植入后,25例患者的动脉狭窄程度从治疗前的76.9%(50%～98%)下降至5.2%(0～30%),残余狭窄率为3%～25%,远端血供良好。除1例患者支架植入过程中对比剂外渗和1例出现脑血管痉挛外,无严重并发症发生。结论在严格把握适应证下行椎-基底动脉狭窄支架植入治疗,手术成功率较高,再狭窄率低,可明显减少脑卒中的风险。

Objective To investigate the efficacy and safety of endovascular stent implantation for the treatment of vertebrobasilar artery （VBA） stenosis. Methods During the period from March 2009 to Nov. 2010, a total of 25 patients with symptomatic VBA stenosis were admitted to authors＇ hospital. Digital subtraction angiography demonstrated that there were 26 responsible arteries in 25 patients. Clinical manifestations included transient cerebral ischemic attack （n = 7） and symptomatic cerebral apoplexy （n = 18）. Angioplasty and stent implantation were carried out in all the 25 patients. Follow-up observations of clinical symptoms and stent condition were conducted at 1, 6 and 12 months after the treatment to identify whether there was re-stenosis or not. Results Immediately after the stent implantation was accomplished, the mean degree of VBA stenosis in 25 patients decreased from preoperative 76.9% （50% - 98% ）to postoperative 5.2% （0% - 30% ） with a residual stenosis rate of 3% - 25%. The distal blood supply was quite good. No severe complications occurred except mild contrast media extravasation in one case and cerebral vasospasm in another case which occurred during the stenting procedure. Satisfactory short-term results were obtained in all patients. Conclusion For the treatment of VBA stenosis by using stent implantation higher technical success rate and lower occurrence of re-stenosis can be achieved, provided the indications are strictly observed. And the risk of cerebral apoplexy can be remarkably reduced.