球囊扩张支架成形术治疗椎动脉狭窄致后循环脑缺血的效果分析

Treatment of post circulation ischemia with vertebral artery stent angioplasty

目的总结因椎动脉狭窄致后循环脑缺血的患者行支架成形手术的经验体会。方法 47例因椎动脉狭窄致缺血性脑卒中的患者,于我科行椎动脉支架成形术,共留置支架52枚,其中椎动脉V1段为46枚,V4段6枚。所有患者行全脑血管造影或CT血管造影随访,平均随访6.3月。分析动脉狭窄改善及其他并发症情况。结果所有患者均成功行支架成形术。术后患者症状缓解率为85.1%(40/47);术前狭窄率(75.2±6.7)%,术后狭窄率为(7.6±6.1)%。发生支架内再狭窄(IRS)9处(17%),8处为椎动脉起始部,1处为V4段。结论支架成形术是治疗缺血性椎动脉狭窄安全有效的方法,但应尽量避免IRS等术后并发症。

Objective To present treatment results with stent angioplasty of vertebral stenosis in post circulation ischemic patients. Methods Vertebral artery stent angioplasty were proformed in totally 47 patients confrmed vertebral artery stenosis with 52 stents. Among them, there were 46 stents implanted in vertebral ostim and 6 stents in V4 segment. All of the patients were followed by digital distraction angiography（DSA） and CT angiography. Average follow up duration was 6.3 months. Results ALL the stents were implanted successfully. Symptoms were improved in 85.1%（40/47） of the patients. The stenosis rate before stenting were （75.2±6.7）% compared with （7.6±6.1）% post stenting. In-stent recurrent stenosis （IRS） were conformed in 9（17%） stents, however 8 stents were implanted in vertebral ostium（V1 segment）,1 stent were in V4 segment. Conclusions In experienced hands, stenting for symptomatic VAS can be accomplished with a very high success rate （100%）,with few complications. We conclude that endovascular stenting of vertebral artery stenosis is safe and effective for ischemic disease.IRS should be avoided.