单枚自膨式支架置入治疗椎动脉起始部合并锁骨下动脉狭窄的疗效分析

摘要

目的：探讨置入单枚自膨式支架同时治疗椎动脉起始部合并邻近锁骨下动脉狭窄的技术可行性和疗效。方法采用单枚支架置入同时治疗有后循环缺血症状的椎动脉起始部狭窄（狭窄率≥70％）合并邻近锁骨下动脉狭窄（狭窄率≥50％）的患者21例。术中将1枚自膨式开环支架的头端放置于椎动脉V1段的中远端，尾端放置于锁骨下动脉的近端。术后6～12个月行CT血管成像（CTA）和（或）DSA随访。回顾性分析患者的临床和影像资料。结果全部支架成功置入，椎动脉平均狭窄率由术前（87.1±5.7）％降至（7.4±6.4）％（中位数5％，范围0％～20％），锁骨下动脉狭窄率由（61.9±8.4）％降至（4.5±5.7）％（中位数0％，范围0％～20％），差异均有统计学意义（均P＜0.05）；无围手术期并发症发生。随访中发现1例（4.8％）患者椎动脉支架内再狭窄（狭窄率约50％），但无相关临床症状；1例（4.8％）术后6个月再发眩晕，复查CTA和DSA，显示支架压缩合并椎动脉闭塞。结论单枚自膨式支架置入同时治疗椎动脉起始部合并邻近锁骨下动脉狭窄，技术可行且安全，支架内再狭窄和支架压缩的发生率较低。%Objective Toinvestigatethetechnicalfeasibilityandefficacyofvertebralarteryorigin and adjacent subclavian artery stenosis treated with a single self-expandable stent implantation simultaneously. Methods Twenty-onepatientswithposteriorcirculationischemicsymptomsweretreatedwithasingle stent implantation for vertebral artery origin (stenosis rate≥70%)and adjacent subclavian artery stenosis (stenosis rate ≥50%)simultaneously. The head end of a single self-expandable open-cell stent was implanted into the middle or distal V1 segment of vertebral artery,and the caudal end was implanted at the proximal subclavian artery during procedure. At 6 -12 months after procedure they received followed-up with CTA and/or DSA. The clinical and image data of the patients were analyzed retrospectively. Results Allstentswereimplantedsuccessfully.Thevertebralarterystenosisratewasdecreasedfrom 87. 1 ± 5. 7% before procedure to 7. 4 ± 6. 4% and the subclavian artery stenosis rate was decreased from 61.9±8.4% to4.5±5.7% aftertheprocedure.Therewassignificantdifference(allP<0.05).No perioperative complications occurred. The in-stent restenosis (about 50%) was found in one patient (4.8%)during the follow-up and he did not have any relevant clinical symptoms. One patient (4. 8%) had recurrent vertigo at 6 months after procedure. CTA and DSA examinations revealed stent compression and vertebralarteryocclusion.Conclusion Asingleself-expandablestentimplantationforthetreatmentof vertebral artery origin and adjacent subclavian artery stenosis simultaneously is feasible and safe. The incidences of in-stent stenosis and stent compression are low.