经股动脉路径椎动脉开口狭窄支架成形术手术成功率的影响因素分析

Factors influencing the success rate of stenting for vertebral artery stenosis via the femoral artery

目的探讨影响经股动脉路径椎动脉开口狭窄支架成形术手术成功率的因素。方法回顾性分析315例经股动脉路径椎动脉狭窄开口支架成形术患者的临床资料,根据椎动脉狭窄支架成形术是否成功支架植入的情况,分别设为手术成功组与手术未成功组,调查腹主动脉走行、主动脉弓分型、椎动脉部位、椎动脉V1段与锁骨下动脉远心段长轴夹角、椎动脉V1段走行等资料。结果315例患者中共接受334例次经股动脉椎动脉开口狭窄支架成形术,其中左侧椎动脉开口狭窄支架成形术166例,右侧椎动脉开口狭窄支架成形术168例,手术失败30例,其中左侧6例,右侧24例,手术成功率为91%。2组在腹主动脉走行、主动脉弓分型、椎动脉部位、椎动脉V1段与锁骨下动脉远心段长轴夹角、椎动脉V1段走行迂曲成角方面差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,腹主动脉严重迂曲、Ⅱ型及Ⅲ型主动脉弓、右侧椎动脉、椎动脉V1段与锁骨下动脉远心段长轴夹角>90。、椎动脉VI段迂曲成角是椎动脉开口狭窄支架成形术手术未成功的独立危险因素。结论腹主动脉严重迂曲、Ⅱ型及皿型主动脉弓、右侧椎动脉、椎动脉VI段与锁骨下动脉远心段长轴夹角>90。、椎动脉V1段迂曲成角均可能增加椎动脉开口狭窄支架成形术手术失败的风险。

Objective To investigate the determinants of success of stenting for vertebral artery stenosis via the femoral artery.Methods The clinical data on 315 patients with vertebral artery stenosis treated with stenting via the femoral artery was retrospectively analyzed.According to success or failure of stenting for vertebral artery stenosis,the patients were divided into the successful group and unsuccessful group.The course of the abdominal aorta,classification of the aortic arch,position of the vertebral artery,the angle between V1 segment of the vertebral artery and distal segment of the subclavian artery,and course of V1 segment of the vertebral artery were investigated.Results A total of 334 stents were performed in 315 patients,involving 166 of cases of left vertebral artery ostium stenosis and 168 cases of right vertebral artery orifice stenosis.Stent implantation failed in 30 patients,6 of whom suffered from stenosis on the left side and 24 on the right side.The success rate of surgery was 91%.There were significant differences in the course of the abdominal aorta,classification of the aortic arch,location of the vertebral artery,the angle between V1 segment of the vertebral artery and distal segment of the subclavian artery,and the tortuous angle of V1 segment of the vertebral artery between the two groups,respectively(P<0.05).Multivariate logistic regression analysis showed that severe abdominal aortic tortuosity,type Ⅱ and type Ⅲ aortic arches,the right vertebral artery,anangle above 90°between V1 segment of the vertebral artery and the distal part of the subclavical artery and the tortuous angle of V1 segment of the vertebral artery were independent risk factors for unsuccessful stenting of vertebral artery ostium stenosis.Conclusion Severe abdominal aortic tortuosity,type Ⅱ and type Ⅲ aortic arches,the right vertebral artery,a more-than-90 angle between VI segment of the vertebral artery and distal segment of the subclavian artery and the tortuous angle of V1 segment of the vertebral artery may increase the risk of stent failure in patients with vertebral artery stenosis.