血管内支架成形术治疗症状性椎动脉开口狭窄105例临床观察

Clinical Observation on Endovascular Stenting for Treatment of Symptomatic Stenosis of Vertebral Artery Origin: A Report of 105 Cases

目的观察血管内支架成形术治疗症状性颈椎动脉开口狭窄的疗效及安全性。方法 105例症状性椎动脉开口狭窄患者行椎动脉开口支架成形术,观察其成功率、围术期并发症及临床疗效。结果 105例患者椎动脉开口共成功植入105枚球扩式支架,术后即刻造影残余狭窄率为（9.1±3.0）%,成功率达100.00%。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。术后第2-7天和1个月复查椎动脉颅多普勒超声提示血流动力学明显改善,未发现再狭窄。术后1个月总有效率94.29%。术后随访1-36（21±6）个月,支架内再狭窄率24.76%（26/105）,未发现与责任血管相关的短暂性脑缺血发作及脑梗死。结论血管内支架成形术治疗症状性椎动脉开口狭窄能解除血管狭窄,明显改善狭窄椎动脉的血流动力学,并发症少,临床疗效好,是一种安全有效的治疗方法。

Objective To investigate the effect and safety of endovascular stenting for the treatment of symptomatic stenosis of vertebral artery origin. Methods One hundred and five patients with symptomatic stenosis of vertebral artery origin received transradial vertebral stenting. The success rate of operation,peri-operation complication and clinical effect were observed. Results One hundred and five balloon expandable stents were successfully placed in 105 patients with symptomatic stenosis of vertebral artery origin. The rate of residual stenosis following instant angiography was（ 9. 1 ± 3. 0） %.The success rate of operation was 100. 00%. No arterial dissection,intra-stent thrombosis and intracranial hemorrhage were found during peri-operative period. Transcranial color Doppler ultrasonography of vertebral artery performed again2- 7 days and one month after operation suggested that hemodynamics were improved and no restenosis was found. The total effective rate was 94. 29% one month after operation. The postoperative follow-up lasted for 3- 36（ 21 ± 6） months,the rate of intra-stent restenosis was 24. 76%（ 26 /105）,and no responsible artery-related transient ischemic attack and cerebral infarction were found. Conclusion Endovascular stenting for symptomatic stenosis of vertebral artery origin can relieve the vascular stenosis and significantly improve the hemodynamics of the vertebral artery with stenosis,with less complications and better clinical effects,it is a safe and effective therapy.