药物涂层装置治疗椎动脉起始处狭窄病变的临床疗效分析

Clinical efficacy of drug-coated device in treatment of ostial vertebral artery stenosis

目的探讨药物涂层装置在椎动脉起始处狭窄(ostial vertebral artery stenosis,OVAS)患者中应用的安全性和有效性。方法回顾性分析2018年1月到2020年12月复旦大学附属中山医院血管外科连续收治的18例使用药物涂层装置治疗的OVAS患者的临床资料。所有患者术前行电子计算机断层扫描血管造影、磁共振血管造影和(或)颈部血管超声明确狭窄程度,必要时通过数字减影血管造影(DSA)确认。新发病变手术方式为药物涂层球囊(drug-coated balloon,DCB)、DCB+裸支架、药物涂层支架(drug-eluting stent,DES);再狭窄病变手术方式为DCB、DES。观察围手术期技术成功率、临床成功率、不良事件发生情况。术后定期随访,观察病变血管通畅率、随访期不良事件发生率、二次干预率。结果18例患者中新发病变16例、再狭窄病变2例。男性12例,女性6例;年龄54~84岁,平均(67.5±7.8)岁。16例新发OVAS患者中,应用DCB患者6例、DES患者8例、DCB+裸支架患者2例;2例术后再狭窄患者:1例植入DES、1例应用DCB。围手术期1例患者眩晕症状未得到缓解,1例患者发生小脑卒中。技术成功率为94.4%(17/18),临床成功率88.9%(16/18),围手术期不良事件发生率5.6%(1/18)。随访时间3~38个月,平均(15.4±10.9)个月。随访过程中,1例眩晕症状患者好转,未作任何处理;1例脑卒中患者予对症支持治疗后好转;1例新发病变DCB扩张后,于术后第3个月发生再狭窄。随访过程中血管通畅率94.4%(17/18)、不良事件发生率5.6%(1/18)、二次干预率0%。结论药物涂层装置治疗在OVAS患者中应用再狭窄率低,安全有效。

Objective To evaluate the safety and effectiveness of drug-coated devices for patients with ostial vertebral artery stenosis(OVAS).Methods Clinical data of 18 consecutive OVAS patients treated with drug-coated devices admitted to the Department of Vascular Surgery of Zhongshan Hospital,Fudan University from January 2018 to December 2020 were retrospectively analyzed.All patients underwent preoperative computed tomography angiography,magnetic resonance angiography and/or carotid ultrasound to clarify the degree of stenosis,and confirmed by digital subtraction angiography if necessary.Surgical methods for new OVAS lesion were:drug-coated balloon(DCB),DCB+bare metal stent,drug-eluting stent(DES);for restenotic OVAS lesion were:DCB,DES.The perioperative clinical success rate,technical success rate,incidence of adverse events were observed.Regular postoperative follow-up was performed to observe the vascular patency rate,the incidence of adverse events and the rate of secondary interventions.Results Among 18 patients,16 had new lesions and 2 had restenotic lesions.There were 12 males and 6 females;ages ranged from 54 to 84 years old,with a mean age of(67.5±7.8)years old.16 patients with new OVAS:6 patients with DCB,8 patients with DES,and 2 patients with DCB+bare metal stent;2 patients with restenosis OVAS:1 patient with DES and 1 patient with DCB.One patient had unrelieved vertigo symptoms and one patient had a cerebellar stroke during the perioperative period.The technical success rate was 94.4%(17/18),the clinical success rate was 88.9%(16/18),and the incidence of perioperative adverse events was 5.6%(1/18).The follow-up time was 3-38 months with a mean follow-up time of(15.4±10.9)months.One patient with vertigo symptoms improved during the follow-up period without any treatment,and one patient with stroke improved after symptomatic support treatment without any treatment.During follow-up,restenosis occurred in one new lesion patient in 3 months post-treatment.The vascular patency rate was 94.4%(17/18),the incidence of adverse events was 5.6%(1/18),the rate of secondary intervention was 0%.Conclusions Drug-coated device is safe and effective for the treatment of OVAS patients with low restenosis rate.