椎动脉V1段解剖分型对椎动脉狭窄支架成形术技术指标的影响

Effect of anatomic classification of V1 segment of vertebral artery on the technical indexes of stenting for vertebral artery stenosis

目的探讨椎动脉V1段解剖分型对椎动脉支架成形术技术指标的影响。方法回顾性分析256例椎动脉支架成形术资料,根据椎动脉V1段与锁骨下动脉远心段长轴夹角将椎动脉V1段解剖路径分为Ⅰ、Ⅱ型:椎动脉V1段与锁骨下动脉远心段长轴夹角<90°者为Ⅰ型,椎动脉V1段与锁骨下动脉远心段长轴夹角>90°者为Ⅱ型。分析椎动脉V1段解剖分型对不同手术路径的手术成功率、操作X线曝光时间、对比剂用量及操作相关并发症的影响。结果253例患者完成支架成形术。选择股动脉路径进行椎动脉狭窄支架置入术223例(Ⅰ型210例,Ⅱ型13例),Ⅰ型患者手术成功率高于Ⅱ型患者(P<0.05);Ⅰ型椎动脉患者较Ⅱ型患者在曝光时间、使用对比剂量方面均明显减少(P<0.01)。选择桡动脉路径进行椎动脉狭窄支架置入术30例(Ⅰ型20例,Ⅱ型10例),Ⅰ型患者手术成功率低于Ⅱ型患者(P<0.05);Ⅰ型椎动脉患者较Ⅱ型患者在曝光时间、使用对比剂量方面均明显增多(P<0.01)。经股动脉路径椎动脉狭窄支架置入术时,Ⅱ型并发症发生率较Ⅰ型显著增加(P<0.05)。结论椎动脉V1段形态学特征影响椎动脉支架成形术技术指标,椎动脉V1段与锁骨下动脉远心段夹角为Ⅰ型者首选经股动脉路径椎动脉狭窄支架成形术,Ⅱ型者首选经桡动脉路径。

Objective To explore the effect of V1 segment of the vertebral artery on the technical indexes of vertebral artery stenting.Methods 256 cases of vertebral artery stenting were retrospectively analyzed.According to the angle between the V1 segment of vertebral artery and the distal segment of subclavian artery,the anatomical pathway of V1 segment of vertebral artery was divided into type I and type II.The angle between V1 segment of vertebral artery and distal segment of subclavian artery with long axis angle less than 90°was type I.The angle between V1 segment of vertebral artery and distal segment of subclavian artery with long axis angle>90°was type II.The effect of anatomical variation of the 1 segment of the vertebral artery on the success rate of different operation paths,X-ray exposure time,contrast agent dosage and operation related complications was analyzed.Results 223 cases(210 cases of typeⅠand 13 cases of typeⅡ)were treated with stent placement for vertebral artery stenosis via femoral artery.The success rate of typeⅠpatients was higher than that of typeⅡpatients(P<0.05).Compared with typeⅡpatients,the exposure time and contrast dose of typeⅠpatients were significantly reduced(P<0.01).30 cases(20 cases of typeⅠand 10 cases of typeⅡ)of vertebral artery stenosis were treated by radial artery approach.The success rate of typeⅠpatients was lower than that of typeⅡpatients(P<0.05);Compared with typeⅡpatients,the exposure time and contrast dose of typeⅠpatients increased significantly(P<0.01).The incidence of complications in typeⅡpatients treated with stent placement for vertebral artery stenosis via femoral artery was significantly higher than that in typeⅠpatients(P<0.05).Conclusion The morphological characteristics of V1 segment of vertebral artery affect the technical indexes of vertebral artery stenting.Stent placement for vertebral artery stenosis via femoral artery is the first choice for typeⅠpatients,while for typeⅡpatients,radial artery is first-choice access.