经桡动脉途径血管内支架成形术治疗老年症状性椎动脉狭窄的临床研究

Transradial endovascular stenting in elderly patients with symptomatic vertebral artery stenosis

目的探讨经桡动脉途径血管内支架成形术治疗老年症状性椎动脉狭窄的有效性和安全性。方法选择老年症状性椎动脉狭窄患者45例,行经桡动脉途径椎动脉支架成形术,观察其手术成功率、围术期并发症及临床疗效。结果 45例患者中,椎动脉开口置入球扩式支架43枚,椎动脉颅内段置入自膨式支架2枚,术后即刻造影,残余狭窄<20%,技术成功率达100%。围术期未发生动脉夹层、支架内血栓形成、颅内出血等并发症。与术前比较,术后临床症状明显好转,术后2～7d血流动力学明显改善(P<0.01)。总有效率93.3%。术后随访3个月～4年,平均(24±8)个月,支架内再狭窄12例(26.7%),无与责任血管相关的短暂性脑缺血发作及后循环脑梗死发生。结论经桡动脉途径血管内支架成形术治疗老年症状性椎动脉狭窄临床疗效好,并发症少,是一种安全有效的治疗方法。

Objective To study the efficacy and safety of transradial endovascular stenting in elder- ly patients with symptomatic vertebral artery stenosis. Methods The success rate of transradial vertebral stenting,its perioperative complications and outcomes in 45 patients with symtomatic vertebral stenosis were observed. Results 55 balloon expandable stents were placed through the orifice of vertebral artery and 2 self-expandable stents were placed through the intracranial seg- ment of vertebral artery in the 45 patients with a success rate of 100%. Instant angiography showed that the residual stenosis was ~20% after operation with no perioperative complications, such as thrombosis in arterial dissection and stents and intracranial bleeding. The clinical syrup toms and hemodynamics were significantly improved 2-7 days after operation as compared with those before operation （P〈0.01）. The overall effective rate was 93.3%. The patients were fol- lowed up for 3 months-4 years （mean 24±8 months） ,during which restenosis occurred in 12 pa- tients （26.7%） with no responsible artery related transient cerebral ischemia and posterrial circu- lation ischemic stroke. Conclusion Transradial endovascular stenting is a safe and effective proce- dure for elderly patients with symptomatic vertebral artery stenosis with few complications.