Wingspan支架治疗重度症状性颅内椎动脉粥样硬化性狭窄的疗效评价

Efficacy evaluation of Wingspan stents for severe symptomatic intracranial vertebral artery atherosclerotic stenosis

目的探讨Wingspan支架治疗重度症状性颅内段椎动脉粥样硬化性狭窄的安全性及短中期疗效。方法回顾性分析2007年4月—2013年2月,因药物治疗无效而选择Wingspan支架置入治疗的椎动脉颅内段重度狭窄患者40例(共42处狭窄)的临床和影像学资料,分析椎动脉狭窄形态、技术成功率、围手术期并发症、临床及影像随访结果。结果①本组患者支架成形术的技术成功率为100%,术后平均狭窄率[中位数(M),范围]从75.4(54.3～99.0)%下降至10.0(0～40.0)%。②所有患者获得[中位数(M),范围]30.5(2～72)个月的临床随访,其中19例获得平均9个月(0.5～47)个月的DSA造影随访,14例获得平均8(2～35)个月的CT血管造影或MR血管造影随访。3例(7.5%)患者于30 d内发生了卒中,其中1例为术后24 h内发生的非致残性小卒中,1例为24 h内的栓塞事件所致的致残性卒中,1例为术后1周的亚急性支架内血栓形成所致的致残性卒中。1例(2.5%)患者发生30 d后非致残性的小卒中。随访中4例患者发生支架内再狭窄(12.9%,4/31),其中3例位于入颅段,1例为症状性再狭窄。结论 Wingspan支架治疗重度症状性颅内段椎动脉粥样硬化性狭窄的技术成功率高,治疗相对安全,中短期疗效较好。但支架置于入颅段椎动脉狭窄处,再狭窄率较高,长期疗效有待进一步观察。

Objective To investigate the safety, short-and medium-term efficacy of Wingspan stents in the treatment of severe symptomatic intracranial vertebral artery atherosclerotic stenosis. Methods The clinical and imaging data of 40 consecutive patients with severe intracranial vertebral artery stenosis （42 ste-noses） who selected Wingspan stenting due to the failure of medical therapy from April 2007 to February 2013 were analyzed retrospectively. The morphology of vertebral artery stenosis, technical success rate, peri- operative complications, and clinical and imaging follow-up results were analyzed. Results ①The techni-cal success rate of stent angioplasty in patients of this group was 100%. The mean stenosis rate decreased from 75.4% （median [ M] range 54.3% to 99% ） to 10.0% （0 to 40% ） after procedure. ②All the pa-tients were followed up clinically for 30.5 （M 2 to 72） months, among them 19 were followed up with DSA for a mean of 9 months （ range 0.5 to 47） , and 14 were followed up with CT angiography or MR angiogra-phy for a mean of 8 months （range 2 to 35）. Three patients （7.5%） had stroke within 30 days after the procedure, one of them had minor stroke within 24 hours but without disabling, one had embolic event caused disabling stroke within 24 hours, and the other one had subacute in-stent thrombosis caused disab-ling stroke. One patient （2.5%） suffered minor stroke after day 30 but without disabling. Four patients （12.9%） had restenosis during the follow-up period, 3 of them were located in the cranial-entering seg-ments, and 1 had symptomatic restenosis. Conclusion Technical success rate of the Wingspan stents is high in the treatment of severe symptomatic intracranial vertebral artery atherosclerotic stenosis. The treat-ment is relatively safe, and the short-and medium-term efficacy is good. However, both the residual steno-sis rate and restenosis rate are higher in the treatment of stenosis by implanting stents into the cranial-ente-ring segments of vertebral artery. The long-term efficacy remains to be further observed.