自膨式颈动脉支架治疗椎动脉起始部中重度狭窄的疗效分析  

Self-expanding carotid stent for the treatment of moderate to severe stenosis at the origin of vertebral artery:an efficacy analysis

作　　者：黄清海[1] 张永巍[1] 刘建民[1] 洪波[1] 许奕[1] 赵文元[1] 

机构地区：[1]第二军医大学附属长海医院临床神经医学中心,上海200433

出　　处：《中国脑血管病杂志》2011年第1期4-7,共4页Chinese Journal of Cerebrovascular Diseases

基　　金：上海市科委重点项目 (074119506)

摘　　要：目的探讨采用自膨式颈动脉支架治疗椎动脉起始部中、重度狭窄的短期疗效、安全性及预防再狭窄的作用。方法回顾性分析采用自膨式颈动脉支架对椎动脉起始部狭窄率>50%,并且常规药物治疗无效的23例患者的临床资料。术后采用血管超声、MR血管成像及DSA进行影像学随访。结果①23例患者均成功置入支架(技术成功率为100%),平均狭窄率从术前的(70±8)%降至(10±6)%。无手术并发症发生。②术后临床随访3～25个月,无一例患者出现短暂性脑缺血发作或卒中复发;19例症状改善。21例超声随访无再狭窄发生,12例接受6个月以上的血管造影随访,无一例发生支架内再狭窄或支架变形。结论应用自膨式颈动脉支架治疗椎动脉起始部中、重度狭窄,短期是安全、有效的,可防止支架变形并降低支架内再狭窄的危险;但长期疗效尚有待进一步观察。Objective To investigate the short-term efficacy, safety and the role of preventing restenosis of self-expanding carotid stents in the treatment of nrxlerate to severe stenosis at the origin of vertebral artery. Methods The clinical data of 23 patients with stenosis（ 〉50% ） at the origin of vertebral artery treated using self-expanding carotid stents were analyzed retrospectively. All of the patients were failure to respond to conventional medical therapy, The patients were followed up with vascular ultrasonography, MRA and DSA after the procedure. Results （1）All stents were implanted successfully in all the 23 patients. The mean stenosis rate from 70±8% before the procedure decreased to 10 ±6%. No technical complications occurred. （2）Clinical followed up for 3 to 25 months after the procedure, no patient had transient ischemic attack or recurrence of stroke. The clinical symptoms improved in 19 patients. Twenty-one patients were followed up with ultrasonography and no restenosis occurred. Twelve patients were followed up with angiography for more than 6 months, and no instent restenosis or stent deformation occurred. Conclusion Using self-expanding carotid stents for the treatment of severe stenosis at the origin of vertebral artery is safe and effective. It may prevent stent deformation and reduce the risk of in-stent restenosis ; however, the long-term efficacy remains to be further observed.

关 键 词：椎底动脉供血不足 支架 血管成形术 治疗结果 

分 类 号：R743.3[医药卫生—神经病学与精神病学]