经皮血管内支架成形术治疗椎-基底动脉狭窄疗效观察  

The clinical effect of percutaneous transluminal angioplasty and stent in vertebrobasilar artery stenosis

作　　者：李郁芳[1] 蒋初明[2] 李冬华[2] 叶容臻[1] 李宇东[1] 李燕[1] 张静[1] 缪中荣[3] 

机构地区：[1]北京航天总医院医学影像中心,100076 [2]北京航天总医院神经内科,100076 [3]首都医科大学宣武医院神经外科介入放射诊断治疗中心

出　　处：《中国现代神经疾病杂志》2008年第4期323-328,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：北京市首都医学发展科研基金资助项目(项目编号:2005-3028)

摘　　要：目的评价经皮血管内支架成形术治疗椎-基底动脉狭窄的安全性、有效性和中短期疗效。方法23例椎-基底动脉狭窄患者施行经皮血管内支架成形术,共检出25个狭窄病变,其中22个位于椎动脉起始段(左侧13个,右侧9个),1个位于椎动脉颅内段,2个位于基底动脉。共成功植入26枚球囊支架,金属裸支架15枚,药物洗脱支架11枚;基底动脉植入2枚,椎动脉植入24枚。其中1例基底动脉急性闭塞患者采用尿激酶动脉溶栓辅助药物洗脱支架治疗。结果23例患者施行经皮血管内支架成形术后血管平均狭窄率从治疗前的81.40%(50%～95%)降至6.30%(0～15%)。20例患者平均持续随访21个月,17例(85%)症状明显缓解或消失,3例(15%)部分缓解;2例复发患者中1例再次血管内植入药物洗脱支架后血管开通良好,1例拒绝接受再次治疗。结论经皮血管内支架成形术治疗椎-基底动脉狭窄安全、有效,中短期疗效满意。药物洗脱支架对手术后支架内再狭窄具有一定的预防作用且优于金属裸支架,若手术后积极辅以抗血小板治疗可进一步提高药物洗脱支架治疗椎-基底动脉狭窄的有效性。Objective To evaluate the safety, efficacy and clinical effect of percutaneous transluminal angioplasty and stent （PTAS） in vertebrobasilar artery stenosis. Methods Twenty-three patients with verte- brobasilar artery stenosis were treated by PTAS. Twenty-five stenotic lesions were detected in 23 patients. Twenty-two lesions were found at the inital segment of vertebral artery （13 at left, 9 at right）, one was detected at the intracranial segment of vertebral artery, and 2 were seen at basilar artery. Twenty-six balloon stents were successfully implanted [15 bare metal stents （BMS） and 11 drug eluting stents （DES）]. Among them, 2 were implanted in basilar artery and 24 in vertebral artery. One patient with acute basilar artery occlusion was treated by urokinase thrombolytic therapy assisted with DES implantation. Results After treatment, the average stenosis rate in 23 patients was reduced from 81.40% （50%-95%） to 6.30% （0-15%）. The mean follow-up period of 20 patients was 21 months. Obvious remission or symptom disappearance was seen in 17 （85%） cases and partial remission in 3 （15%） cases. Recurrence occurred in 2 patients, one patient received endovascular DES implantation and the vascular occlusion completely relieved, but another one rejected retreatment. Conchlsion Percutaneous transluminal angioplasty and stent for vertebrobasilar artery stenosis is safe and effective. The middle and short-term outcomes are good. Drug eluting stent is better than bare metal stent in the protection of intrastent restenosis. After operation, active treatment with antiplatelet agent may enhance the efficacy of drug eluting stent for vertebrobasilar artery stenosis.

关 键 词：血管成形术 椎底动脉供血不足 支架 

分 类 号：R743.3[医药卫生—神经病学与精神病学]