Wingspan支架治疗重度症状性椎-基底动脉狭窄

Wingspan stent for severe symptomatic atherosclerotic stenosis of the vertebrobasilar artery

目的总结Wingspan支架治疗重度症状性颅内椎一基底动脉狭窄的经验。方法回顾性分析30例共31处重度症状性椎一基底动脉狭窄病人的临床资料。所有病人均经Wingspan治疗，通过改良Rankin评分（modifledrankingscale，MRS）和美国国家卫生院脑卒中量表（nationalinstitutesofhealthstrokescale，Nn-ISS）进行临床评估。结果手术成功率100％，血管平均狭窄度由术前（82．3±8．O）％降至（11．2±7．3）％，手术前后狭窄度经统计学分析有显著差异（P〈0．05）。围手术期并发症包括脑桥梗死2例和支架叠加导致一过性血流灌注不足1例。临床随访27例。时间5-40个月。影像学随访19例，时间5-20个月。1例发生症状性再狭窄，其他无再狭窄和缺血事件。结论Wingspan支架植入是药物治疗无效的颅内血管狭窄的有效、安全的方法，但需注意围手术期并发症的防治。对远期结果有待进一步观察。

Objective To summarize the experiences with Wingspan stent in the treatment of severe symptomatic atherosclerotic stenosis of the vertebrobasilar artery. Methods Clinical data of 30 patients with 31 severe symptomatic atherosclerotic stenoses in the vertebrobasilar artery were analyzed retrospectively. All the patients were treated with Wingspan stent. The modified Rankin scale （MRS） and national institutes of health stroke scale （NIHSS） were used for clinical evaluation. Results The surgical success rate was 100%. The mean stenosis degree of the artery was 82.3 ~ 8.0 % before surgery and 11.2 ~ 7.3 % after surgery. There was an obvious difference in stenosis degree of artery before and after surgery （P 〈 0.05）. Perioperative complications such as pontine infarction oeeurred in 2 patients and transient hypoperfusion caused by stents stacking was seen in 1 patient. Clinical follow-up was performed on 27 patients and the period was from 5 to 40 months. Imaging follow-up was performed on 19 patients and the period was from 5 to 20 months. Symptomatic restenosis occurred in 1 patient. No other restenoses and ischemic events occurred. Conclusions The implantation of Wingspan stent is an effective and safe treatment for medically intractable intracranial artery stenosis. However, prevention and control ofperioperative complications should be noticed and the long-term outcomes need further observation.