血管内支架成形术治疗椎基底动脉狭窄  

Endovascular stenting for vertebrobasilar artery stenosis

作　　者：刘建民[1] 洪波[1] 许奕[1] 黄清海[1] 赵文元[1] 张珑[1] 张鑫[1] 辛涛[1] 周晓平[1] 

机构地区：[1]第二军医大学长海医院神经外科,上海200433

出　　处：《中华放射学杂志》2002年第12期1063-1067,共5页Chinese Journal of Radiology

基　　金：上海市医学发展基金重点研究课题 (98ZD0 0 2 )

摘　　要：目的　初步总结应用血管内支架成形术治疗椎基底动脉狭窄的经验 ,探讨其适应证、技术要点和围手术期处理。方法　 2 0例表现为反复的短暂性脑缺血发作或既往有后循环梗塞病史 ,13例为反复头晕发作或血管性头痛。椎动脉起始段 13例 ;椎动脉颅外段 3例 ,颅内段 5例 ;基底动脉12例。病变狭窄程度均在 70 %以上 ,狭窄长度 2～ 12mm。所有患者接受血管内支架成形术治疗 ,将球囊膨胀型支架 (BX ,AVES670 ,EXPRESS ,BIODIVESO)在微导丝导引下通过狭窄部位 ,缓慢充盈球囊 ,造影观察支架释放情况后缓慢回撤球囊。结果　 2 9例恢复正常管径 ,4例狭窄程度减小 80 %以上 ,无内膜撕裂和血栓形成。临床随访 3～ 10个月 ,所有患者均恢复满意 ,无短暂性缺血再发作或卒中 ;影像学随访 10例患者 ,均无血管再狭窄。结论　椎基底动脉狭窄的血管内支架成形术治疗椎基底动脉狭窄是一种有效、安全的方法 。Objective To summarize the experiences in endovascular stenting for vertebrobasilar artery stenosis, and to discuss its indications, technique, and perioperative management Methods Twenty cases presented with recurrent transient ischemic attack or with the history of infarction of posterior circulation territory Thirteen cases complained of dizziness or headache The locations of the stenoses were originated at vertebral artery in 13 cases, extracranial segment of vertebral artery in 3 cases, intracranial segment of vertebral artery in 5 cases, and basilar artery in 12 cases All stenoses were more than 70% in diameter, with 2-12 mm in length Balloon expended stents (BX, AVES670, EXPRESS, BIODIVESO) were introduced across the stenosis with the support of guide wire Stents were deployed by inflation of the balloon slowly Results There were no procedural and periprocedural complications, and angiographic results showed that the stenoses returned to normal size in 29 cases, while reduced by more than 80% in 4 cases The patients were asymptomatic and neurologically intact at the clinical follow up for 3-10 months Ten cases were followed by angiography, and there was no restenosis Conclusion Endovascular stenting for vertebrobasilar artery stenosis is effective and safe But long term results need further investigation

关 键 词：治疗 椎基底动脉狭窄 椎底动脉供血不足 支架 血管成形术 介入性放射学 

分 类 号：R743[医药卫生—神经病学与精神病学]