症状性椎基底动脉供血不足老年患者的临床干预研究  

Management of elderly patients with symptomatic vertebrobasilar insufficiency

作　　者：陆军[1] 王大明[1] 陈海波[2] 刘加春[2] 刘芳[1] 姜宏志[1] 李金[2] 王利军[1] 龚涛[2] 姜学丽[1] 翟乐乐[1] 

机构地区：[1]北京医院神经外科,100730 [2]北京医院神经内科,100730

出　　处：《中华外科杂志》2007年第4期226-229,共4页Chinese Journal of Surgery

基　　金：国家自然科学基金(30571915);卫生部临床学科重点项目(卫规财发[2001]321号);国家"十五"攻关项目(2004BA714B07)

摘　　要：目的探讨症状性椎基底动脉供血不足老年患者的支架成形术或(和)药物治疗的可行性、安全性和短期疗效。方法选择我院2001年4月至2006年6月诊治的有后循环缺血症状且经血管造影证实有相关椎基底动脉狭窄(狭窄≥50%)的老年患者(年龄≥60岁),所有患者均行内科药物治疗,部分患者还给予椎基底动脉支架成形术治疗,分析其临床、影像学、治疗和随访观察资料。结果共有81例入选本研究,其中男68例,女13例;年龄60～87岁,平均70岁;平均随访28.1个月,81.5%(66/81)的患者临床症状改善或消失;住院及随访期间总卒中发生率为4.9%(4/81),卒中相关死亡率为2.5%(2/81)。本组中有48例(59.3%)患者行支架成形术治疗,52例次,技术成功率为98.1%,动脉狭窄率由术前(82.4±13.1)%降至(6.4±3.2)%(t=22.4,P=0.00)。结论症状性椎基底动脉狭窄老年患者的支架成形术或(和)内科药物治疗的短期疗效良好。Objective To evaluate the feasibility, safety and short-term efficacy of stem-assisted angioplasty and/or drug therapy for elderly patients with symptomatic vertebrobasilar insufficiency. Methods Elderly patients （ ≥ 60 years old） with symptomatic vertebrobasilar stenosis （ ≥ 50% ） demonstrated by cerebral angiography were treated with drug therapy and some with endovascular stenting further from April 2001 to June 2006. The clinical, imaging, intervention and follow-up data were collected and analyzed. Results Eighty-one elderly patients were chosen for study, including 68 males and 13 females. The mean age is 70 years （60-87 years）; stroke rate of 4. 9% （4/81） and stroke-related mortality rate of 2. 5% （2/81） were found in this group during hospitalization and follow-up （mean 28. 1 months） , and symptoms resolved or improved clinically in 66 （81.5%）. Fifty-two balloon expandable stents were placed in 48 （59. 3% ） patients of this group with a technical success rate of 98. 1% and the mean degree of stenosis was reduced from （82.4 ± 13.1）% to （6.4±3.2）% （t =22.4, P=0.00）. Conclusions Appropriate management including endovascular stenting and/or drug therapy may improve short-term outcomes of elderly patients with symptomatic vertebrobasilar insufficiency; meanwhile, stent-assisted angioplasty is technically feasible and relatively safe.

关 键 词：椎底动脉供血不足 支架 药物疗法 老年人 

分 类 号：R743.3[医药卫生—神经病学与精神病学]