药物洗脱支架与金属裸支架治疗椎动脉开口狭窄的疗效

Efficacy of drug-eluting stent and bare metal stent in the treatment of vertebral artery ostium stenosis

目的探讨药物洗脱支架与金属裸支架治疗椎动脉开口狭窄的疗效。方法收集2015年6月至2021年6月青岛大学附属医院收治的230例椎动脉开口动脉粥样硬化狭窄患者的临床资料,按照椎动脉植入支架的不同将其分为药物洗脱支架组(n=121)和金属裸支架组(n=109)。比较两组患者术前狭窄程度、术后即刻血管残余狭窄程度、术后6个月改良Rankin量表(mRS)评分、术后6个月美国国立卫生研究院卒中量表(NIHSS)评分、围手术期并发症、术后至出院前时间、出院时卒中或死亡发生情况。观察两组患者术后支架内再狭窄情况、卒中或短暂性脑缺血发作(TIA)发生情况。结果术后即刻,两组患者血管残余狭窄程度均低于本组术前,差异均有统计学意义(P﹤0.05)。术后6个月,两组患者NIHSS评分、mRS评分均低于本组术前,差异有统计学意义(P﹤0.05)。两组患者均未发生围手术期并发症,术后至出院前时间、出院时卒中或死亡发生率比较,差异均无统计学意义(P﹥0.05)。术后1、6个月,两组患者卒中或TIA发生率比较,差异均无统计学意义(P﹥0.05)。术后12个月,药物洗脱支架组患者再狭窄率为7.55%(8/106),低于金属裸支架组患者的23.53%(24/102),差异有统计学意义(P﹤0.05)。结论药物洗脱支架与金属裸支架治疗椎动脉开口狭窄均安全、有效,可有效改善患者神经功能与日常生活能力,且药物洗脱支架效果更好,可有效降低术后远期支架内再狭窄率、卒中或病死率。

Objective To explore the efficacy of drug-eluting stent and bare metal stent in the treatment of vertebral artery ostium stenosis.Method A total of 230 patients with atherosclerotic stenosis of the vertebral artery ostium who were hospitalized in the Affiliated Hospital of Qingdao University from June 2015 to June 2021 were selected and divided into the eluting stent group(n=121)or bare metal stent group(n=109)according to different stent implantation.The preoperative stenosis degree,the immediate postoperative vascular residual stenosis degree,scores of the modified Rankin scale(mRS)6 months after surgery,scores of National Institute of Health Stroke Scale(NIHSS)6 months after surgery perioperative complications,postoperative to pre-discharge days,and incidence of stroke or death at discharge of two groups were compared.The occurrence of stent restenosis,stroke,or transient ischemic attack(TIA)in two groups after surgery were observed.Result Immediate postoperative vascular residual stenosis in both groups were lower than that before surgery,the differences were statistically significant(P<0.05).The scores of NIHSS and mRS in the two groups 6 months after surgery were significantly lower than those before surgery,the differences were statistically significant(P<0.05).There were no perioperative complications in the two groups,and there was no significant difference between the two groups in the postoperative to pre-discharge days,incidence of stroke or death at discharge(P>0.05).There were no significant difference in the incidence of stroke or transient ischemic attack(TIA)1 month,6 months after surgery between the two groups(P>0.05).The restenosis rate in the eluting stent group was 7.55%(8/106),lower than that in the bare metal stent group of 23.53%(24/102),the differences were statistically significant(P<0.05).Conclusion Drug eluting stent and bare metal stent are safe and effective in the treatment of vertebral artery ostium stenosis,and can effectively improve the neurological function and daily activity,the drug eluting stent have better effect,and can reduce the long term in-stent restenosis,stroke or mortality.