椎基底动脉狭窄的血管内支架成形治疗(附24例分析)  

Percutaneous transluminal angioplasty and stenting for vertebrobasilar artery stenosis:analysis of 24 cases

作　　者：李生[1] 李宝民[1] 王君[1] 曹向宇[1] 

机构地区：[1]中国人民解放军总医院神经外科,北京100853

出　　处：《中国微侵袭神经外科杂志》2006年第11期491-493,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨经皮血管内支架成形术(PTAS)治疗椎基底动脉狭窄的有效性、安全性及可行性。方法对24例(26处)经药物治疗无效的症状性椎基底动脉狭窄病人采用经股动脉支架血管内成形术治疗。术前DSA示动脉直径狭窄率为60%～90%,平均(80.8±9.7)%。结果本组支架置放成功率96.2%。PTAS术后即刻复查DSA,示22处(88.0%)动脉狭窄的内腔直径扩大至正常的90%以上,3处(12.0%)超过60%;术后平均狭窄率4.4%。按NIHSS评分进行评估,术后明显改善15例,无变化7例,加重并死亡2例。随访1～30个月,行MRA复查2例,TCD复查14例(17次),DSA复查5例;1例术后1个月发生支架内再狭窄且出现脑缺血发作,经再次PTAS治愈;1例术后1年发生支架内再狭窄,病人无症状,予以动态观察。结论PTAS是治疗症状性椎基底动脉狭窄简便、安全、有效的方法,近期随访效果较好。Objective To study the efficiency, security and feasibility of percutaneous transluminal angioplasty and stenting （PTAS） for symptomatic vertebrobasilar artery stenosis. Methods Twenty-four patients with 26 vertebrobasilar artery stenoses undergoing elective PTAS were retrospectively analyzed. The preoperative symptoms were refractory to medical therapy. DSA showed that the stenosis rate ranged from 60% to 90%, averaging （80.8±9.7）%. Results Success rate of PTAS was 96.2%. Postoperative DSA showed that the caliber of artery stenosis segment was recovered over 90% of the normal diameter in 88.0% of the cases, and over 60% in 12.0~/0. The average stenosis rate after PTAS was 4.4%. Evaluated with NIHSS, 15 cases were obviously improved, 7 unchanged, and 2 aggravated to death. During the follow-up of 1-30 months, ischemia attack recurred in only 1 case. MRA was followed in 2 cases, TCD in 14 with 17 times, and DSA in 5. Images showed that 1 patient occurred restenosis with ischemia attack in 1 month after the treatment, and he was cured by another PTAS; 1 patient occurred restenosis with no symptoms in 1 year after PTAS, and he was treated with ＂wait and see＂. Conclusion PTAS is an easy, safe and effective therapy for patients with vertebrobasilar artery stenosis. The treatment results are good in the short-term follow-up.

关 键 词：椎底动脉供血不足 血管成形术 支架 

分 类 号：R743.3[医药卫生—神经病学与精神病学]