药物洗脱支架与金属裸支架治疗椎动脉开口狭窄的对照研究

Control study of drug-eluting stent versus bare metal stent in treating vertebral artery ostial stenosis

目的对照研究药物洗脱支架与金属裸支架治疗椎动脉开口狭窄的有效性及安全性。方法郑州大学河南省人民医院脑血管介入科自2012年6月至2014年6月应用支架置入术治疗椎动脉开口狭窄患者145例，共154条病变血管接受治疗，其中应用药物洗脱支架94枚，应用金属裸支架60枚。回顾性分析患者的临床资料并比较药物洗脱支架、金属裸支架置入术的疗效和椎动脉再狭窄（50％以上）的发生率。结果患者手术成功率100％，围手术期并发症发生率为0，术后即时造影显示狭窄解除，手术前、术后美国国立卫生研究院卒中量表（NIHSS）评分、改良Rankin评分无明显变化，术后6个月随访：随访119例，失访26例，102（85．7％）例临床症状好转。随访药物洗脱支架治疗组77枚，再狭窄6例（7．8％），金属裸支架治疗组49枚，再狭窄12例（24．5％），统计显示药物洗脱支架治疗后再狭窄发生率明显降低，差异有统计学意义（χ^2=6．818，p=0．009）。结论药物洗脱支架治疗椎动脉狭窄是有效的、安全的，能够有效降低再狭窄的发生。

Objective To compare the efficacy and safety ofdrug-eluting stents and bare metal stents in treating vertebral artery ostial restenosis. Methods A total of 145 patients with vertebral artery ostial stenosis, admitted to our hospital from June 2012 to June 2014 and treated by stent angioplasty, were chosen in our study. Drug eluting stents were used in 84 patients, including unilateral lesions in 77 and bilateral ones in 7; bare metal stents were used in 57 patients; another 3 patients with bilateral lesions used drug eluting stents and bare metal stents at each side; totally, 94 pieces of drug eluting stents and 60 pieces of bare metal stents were used. The clinical data of these patients were retrospectively analyzed; and the treatment efficacy and the incidence of vertebral artery re-stenosis （〉50%） between drug eluting stents and bare metal stents groups were compared. Results The technical success rate was 100%. Procedure-related complication rate, mortality rate, and permanent neurologic morbidity rate at peri-operative period were 0%. Real-time imaging after operating showed artery stenosis disappeared; NIHSS scores, modified Rankin scale scores had no obvious changes before and aider operation; 6 months of follow-up （n=119） indicated 102 （85.7%） patients achieved improved clinical symptoms; re-stenosis rate in drug eluting stents group was 7.8% （6/77） and that in bare metal stents group was 24.5% （12/49）, with significant differences （χ^2=6.818, P=0.009）. Conclusion Stenting and angioplasty of vertebral artery ostial stenosis with drug-eluting stents are effective and safe, which can effectively reduce the re-stenosis rate.