Apollo支架治疗椎动脉起始部动脉粥样硬化性狭窄的效果分析  

Analysis of the therapeutic effect of Apollo stent for atherosclerotic stenosis at the origin of vertebral artery

作　　者：曾张伟 闫亚洲 许奕 洪波 刘建民 黄清海 Zeng Zhangwei;Yan Yazhou;Xu Yi;Hong Bo;Liu Jianmin;Huang Qinghai(Department of Neurosurgery,First Hospital Affiliated to Naval Military Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院神经外科

出　　处：《中国脑血管病杂志》2020年第2期70-75,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家重点研发项目(2016YFC1300703);国家自然科学基金(81571118、81771264)

摘　　要：目的研究Apollo支架应用于椎动脉起始部中重度动脉粥样硬化性狭窄的安全性和长期有效性。方法回顾性分析2014年1月至2019年3月海军军医大学第一附属医院神经外科连续收治的经DSA证实椎动脉起始部狭窄≥50%、采取Apollo支架治疗且随访时间≥6个月的21例患者的临床资料,随访期间行DSA、颈部CT血管成像检查,记录患者治疗前椎动脉狭窄程度、术后即刻残余狭窄程度,围手术期临床症状改变情况,随访过程中支架内再狭窄发生率及后循环缺血事件的发生情况。结果(1)21例患者术前狭窄率为(79±15)%,支架置入成功率为100.0%,术后即刻残余狭窄率中位数为10.0(0,12.5)%,较术前明显降低(Z=-4.01,P<0.01)。1例术后当天出现高灌注现象,未发生与支架置入相关的神经功能恶化或死亡。(2)术后随访6~38个月,中位随访时间为7.0(6.8,13.0)个月,20例(95.2%)患者后循环缺血症状消失或减轻,1例症状反复发作。(3)21例患者中共12例(57.1%)出现支架内再狭窄,其中8例发生于术后6~12个月,4例发生于术后13~38个月;再次治疗患者4例中,1例存在反复后循环缺血症状。(4)6例(28.6%)出现支架断裂,其中4例支架断裂伴中重度支架内再狭窄,2例支架断裂、塌陷伴支架内轻度狭窄。结论Apollo支架治疗椎动脉起始部中重度狭窄可有效缓解狭窄,但长期随访支架内再狭窄率和支架断裂率偏高。Objective To analyze the safety and long-term efficacy of Apollo stent for moderate and severe atherosclerotic stenosis at the origin of the vertebral artery.Methods Twenty-one patients who had a more than 50%of stenosis at the origin of the vertebral artery confirmed by digital subtraction angiography(DSA)and were treated with Apollo stent,were consecutively enrolled from January 2014 to March 2019 in the Department of Neurosurgery of the First Affiliated Hospital,the Navy Military Medical University.They were followed up for more than 6 months with the examination of DSA and neck computed tomographic angiography(CTA).The clinical data were recorded including the degree of stenosis before the operation and residual stenosis after the operation,the change of symptoms during the perioperative period,the rate of in-stent restenosis and the incidence of posterior circulation ischemic events.Results(1)In 21 patients,the median degree of preoperative stenosis was 79.1±15.4%,and the success rate of stent implantation was 100.0%.The median degree of residual stenosis immediately after operation was 10.0(0,12.5)%,which was significantly lower than that before operation(Z=-4.01,P<0.01).Hyperperfusion occurred in 1 patient on the same day after the operation,and there was no deterioration or death of neurological function caused by stent implantation.(2)The follow-up time was from 6 to 38 months,which the median time was 7.0(6.8,13.0)months.The symptoms of posterior circulation ischemia disappeared or relieved in 20 patients,while the ischemic symptoms repeatedly occurred in 1 patient.(3)Among the 21 patients,12 patients(57.1%)had in-stent restenosis(ISR).Of them,8 cases occurred from 6 to 12 months after the operation,4 cases occurred from 13 to 38 months after the operation.Among 4 patients who were re-treated,1 patient had recurrent symptoms of posterior circulation ischemia.(4)Stent fracture occurred in 6 cases(28.6%).Of them,4 cases of stent fracture accompanied by moderate and severe ISR,2 cases of stent fracture or

关 键 词：椎底动脉供血不足 Apollo支架 支架置入术 疗效 

分 类 号：R743.3[医药卫生—神经病学与精神病学]