不同类型支架治疗椎动脉中重度狭窄的疗效分析  

Treatment of moderate to severe vertebral artery stenosis with different types of stents: an efficacy analysis

作　　者：冯明陶 戴琳孙[2] 唐海双 李嘉楠[1] 许奕[1] 洪波[1] 刘建民[1] 黄清海[1] Feng Mingtao;Dai Linsun;Tang Haishuang;Li Jianan;Xu Yi;Hong Bo;Liu Jianmin;Huang Qinghai(Department of Neurosurgery,Changhai Hospital,the Second Military Medical University,Shanghai 200433,China)

机构地区：[1]第二军医大学附属长海医院神经外科,上海200433 [2]福建医科大学附属第一医院神经外科

出　　处：《中国脑血管病杂志》2018年第8期393-397,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金项目(2015J01463)

摘　　要：目的分析不同类型支架在椎动脉中重度狭窄治疗中的安全性和有效性。方法回顾性连续纳入2009年11月至2017年6月,第二军医大学附属长海医院165例和福建医科大学附属第一医院神经外科102例使用支架治疗椎动脉起始部中重度狭窄,共计267例患者的临床资料。根据使用支架的类型,分为裸支架组76例,药物涂层支架组158例,自膨式支架组33例。评价3种支架的安全性及有效性。结果 (1)对267例患者均成功释放支架,围手术期共出现4例并发症,其中裸支架组1例(1.3%,1/76),药物涂层支架3例(1.9%,3/158),自膨式支架组无一例围手术期并发症。3组围手术期并发症发生率差异无统计学意义(P>0.05)。(2)术后3~16个月共随访患者166例,其中裸支架组38例,药物涂层支架组103例,自膨式支架组25例。支架内再狭窄率≥50%共23例,其中裸支架组8例,药物涂层支架组14例,自膨式支架组1例。裸支架组再狭窄发生率(21.1%)>药物涂层支架组(13.6%)>自膨式支架式组(4.0%),3组术后随访再狭窄发生率差异无统计学意义(P>0.05)。结论支架置入治疗椎动脉起始段粥样硬化性狭窄是安全有效的,不同类型支架治疗的再狭窄发生率差异无统计学意义,但需进一步开展前瞻性对照研究加以验证。Objective To analyze the safety and effectiveness of different types of stents for the treatment of moderate to severe vertebral artery stenosis. Methods From November 2009 to June2017,a total of 267 consecutive patients with moderate to severe vertebral artery origin stenosis treated with stents at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University（ n =165） and the Department of Neurosurgery,the First Affiliated Hospital of Fujian Medical University（ n =102） were enrolled retrospectively. According to the types of stents,they were divided into bare stent group（ n =76）,drug-coated stent group（ n =158）,and self-expanding stent group（ n =33）. The safety and efficacy of the three kinds of stents were compared. Results（ 1） The stents were successfully released in 267 patients.Complications occurred in 4 cases during the perioperative period,including one patient（ 1. 3%,1/76） in the bare stent group,3（ 1. 9%,3/158） in the drug-coated stent group,and no perioperative complications in the self-expanding stent group. There was no significant difference in the incidence of perioperative complications among the three groups（ P〉0. 05）.（ 2） A total 166 patients were followed up for 3-16 months after operation,including 38 in the bare stent group,103 in the drug-coated stent group,and 25 in the selfexpanding stent group. The in-stent restenosis rate in 23 patients was≥50%,including 8 in the bare stent group,14 in the drug-coated group,and 1 in the self-expandable group. The incidence of restenosis（ 21. 1%） in the bare stent group was drug-coated group（ 13. 6%） and self-expanding stent group（ 4. 0%）. However,there was no significant difference in the incidence of restenosis among the three groups（ P〉0. 05）. Conclusions Stent placement for the treatment of atherosclerotic stenosis at the vertebral artery originis was safe and effective. There was no significant efficacy difference in the different types of stents. However,further

关 键 词：椎动脉粥样硬化性狭窄 血管内治疗 支架 疗效分析 

分 类 号：R651.1[医药卫生—外科学]