血管内支架置入术治疗症状性椎动脉开口部狭窄的随访研究

Clinical follow-up study of stenting for symptomatic vertebral artery ostium atherosclerotic stenosis

目的探讨椎动脉开口部动脉粥样硬化性狭窄患者行支架置入术治疗的临床疗效及安全性。方法纳入自2006年1月至2013年3月空军总医院神经内科收治的椎动脉开口部支架置入患者共107例进行随访研究。随访时间截止至2014年12月31日。以支架成功置入，残余狭窄≤30％，前向血流通畅为手术成功。临床终点事件定义为：（1）围手术期并发症：支架置入术后30d以内任何卒中和（或）死亡；（2）支架置入效果：支架置入30d后责任血管供血区的缺血性卒中／短暂性脑缺血发作。或支架置入处因再狭窄再次行血管内治疗。主要观察指标为随访期内行数字减影技术或CT血管造影技术检出的再狭窄情况。结果支架置入术成功率为98．1％（105／107），失访率5．7％（6／105），中位随访时间23（14，44）个月。随访期内共7例患者发生终点事件，其中围手术期短暂性脑缺血发作1例（1．O％）；再发责任血管供血区卒中／短暂性脑缺血发作4例，死亡1例；因再狭窄再次置入支架2例。1、3、6、12、24、36、48个月累积终点事件发生率分别为1．0％、2．O％、4．1％、5．2％、5．2％、5．2％及11．8％。78例患者完成影像学随访，平均随访时间（14．9±5．9）个月，37．2％患者（29／78）发生再狭窄，其中10．3％患者（3／29）出现临床症状。结论支架置入术治疗症状性椎动脉开口部狭窄安全性好。中远期随访结果令人满意．应重视围手术期规范用药及术后卒中的综合防治。

Objective To study the clinical follow-up results of patients with symptomatic atherosclerotic stenosis at vertebral artery ostium after stenting. Methods A total of 107 patients were identified that met inclusion criterion between January 2006 to March 2014. Technical success was defined as stent placement of vertebral artery ostium stenosis with stent coverage of the lesions, residual stenosis〈 30%, and good antegrade blood flow. The study endpoint was a composite of any stroke or transient ischemic attack （TIA） or death within 30 days, and ischemic stroke or TIA in vertebrolbasilar artery territory after 30 days. Main outcome measurement included re-stenosis detected by digital subtraction angiography or CT angiography. Results Technical success was obtained in 98.1% patients （105/107） and 5.7% （6/115） were lost to follow-up. The median follow-up time was 23 months （ranged 14 to 44 months）. Seven patients had the endpoint events： one was TIA within 30 days, 4 were ischemic stroke/TIA, one died, and two with restenosis underwent stenting again. The cumulative endpoint events rate at 1, 3, 6, 12, 24, 36 and 48 months were 1.0%, 2.0%, 4.1%, 5.2%, 5.2%, 5.2% and 11.8%. Seventy-eight patients received imaging examination in follow-up term, with mean time of 14.9± 5.9 months; and 29 patients （37.2%） occurred restenosis, and among them 3 patients （10.3%） had symptoms. Conclusion Vertebral artery ostium atherosclerotic stenosis stenting is a safe treatment for severe symptomatic vertebral artery ostium stenosis; medical therapy including antiplatelet therapy, lipid lowing, blood pressure control after stenting should be commended for better ctinical outcomes.