椎动脉起始部狭窄血管内介入治疗中国专家共识(2024版)

Chinese expert consensus on endovascular intervention for vertebral artery ostium stenosis(2024 edition)

椎动脉起始部狭窄(VAOS)是椎动脉狭窄最常见的类型,将导致后循环系统供血减少或继发椎-基底动脉栓塞,产生一系列神经系统功能缺损的临床表现。目前关于VAOS治疗的临床随机对照研究相对较少,其治疗经验主要来自冠状动脉硬化性心脏病、颈动脉狭窄等疾病的治疗,包括药物治疗和血运重建等。血管内介入治疗因其操作简便、创伤小、安全性高等优势,逐渐成为VAOS的首选血运重建策略。但该技术临床应用中仍存在手术指征不明确、手术策略不一致等不足,故本共识结合最新临床研究成果和专家意见,在VAOS术前评估、围手术期管理、血管内介入治疗策略、并发症防治及术后随访内容等方面提出如下意见及建议。

Vertebral artery ostium stenosis(VAOS),a common site of vertebral artery stenosis,could reduce the blood supply of posterior circulation or cause secondary embolism to the vertebral-basilar artery,following with a series of clinical features of neurological dysfunction.Few clinical randomized controlled studies have designed for VAOS treatment;VAOS treatment experiences mainly come from management of coronary heart disease and carotid artery stenosis,including drug therapy and revascularization.Endovascular intervention has become the preferred revascularization strategy for VAOS due to user-friendly control,minimal trauma and high safety.However,there are still some deficiencies in its clinical application,such as unclear surgical indications and inconsistent surgical strategies.This consensus aims to provide suggestions on preoperative evaluation,perioperative management,endovascular interventional strategies,prevention and management of complications,and postoperative follow-up of VAOS based on the latest clinical studies and experts'opinions.