症状性椎基底动脉狭窄患者经皮血管内支架成形术治疗的观察  

Transluminal stent-assisted angioplasty of symptomatic vertebrobasilar artery stenosis

作　　者：刘新峰[1] 李宝民[1] 李生[1] 王君[1] 曹向宇[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《中华老年心脑血管病杂志》2007年第3期177-180,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的评价药物治疗无效的症状性椎基底动脉狭窄患者经皮血管内支架成形术(PTAS)治疗的安全性、可行性。方法28例症状性椎基底动脉狭窄患者,男性25例,女性3例;平均年龄(56．9±10．7)岁。所有患者均按美国国立卫生研究院卒中量表(NIHSS)评分进行评估。结果除1例因血管严重纡曲行PTAS未成功外,27例30处行PTAS成功。全脑血管造影复查显示动脉直径狭窄率从术前平均(79．3±12．1)％降至术后(4．5±7．8)％。PTAS治疗后NIHSS与治疗前比较,差异无显著性意义。PTAS术后临床症状明显改善18例,病情无变化7例,病情加重并死亡2例。随访1～30个月,仅1例出现脑缺血再发作,1例术后1个月发生支架内再狭窄,经再次PTAS治愈;1年后发生支架内再狭窄2例,1例再次行PTAS治愈,1例无症状而动态观察治疗。结论症状性椎基底动脉狭窄应用PTAS治疗,可以减轻患者的临床缺血症状和改善预后。Objective To evaluate the feasibility and safety of transluminal stent-assisted angioplasty of refractory symptomatic vertebrobasilar artery stenosis. Methods Twenty-eight patients with refractory symptomatic vetebro-basilar artery stenosis were treated with transluminal stent-assisted angioplasty. The patients included 25 males and three females aged 36 to 77years（mean 56.9 ± 10.7 years）. Results Twenty-seven cases with 30 lesions were treated with stent-assisted angioplasty successfully. One failure case was due to severe tortuosity of the vessel. The mean degree of stenosis decreased from preprocedural （79.3 ± 12.1） % to postprocedural （4.5 ± 7.8）% examined by DSA. Among the patients evaluated according to NIHSS after the operation, there were significant clinical improvement in 18 cases and unchanged in 7 cases. Two cases were aggravated and died finally. During the follow-up for 1-30 months, symptoms or signs of ischemia recurred in only 1 case. Of the 3 postprocedural restenoses, one occurred in a month and two in a year after PTAS respectively. Two of three with symptom of ischemia were cured by another PTAS. One without symptom was treated with observation. Conclusion Transluminal stem-assisted angioplasty can alleviate symptom of ischemia and improve prognosis of symptomatic vertebrobasilar artery stenosis.

关 键 词：椎底动脉供血不足 支架 血管成形术 经腔 经皮冠状动脉 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]