目的 探讨球囊扩张支架和自膨式支架(Wingspan支架)治疗症状性基底动脉狭窄患者围手术期并发症的情况.方法 回顾性分析2006年11月-2011年6月哈尔滨医科大学附属第一医院神经外科收治的症状性基底动脉狭窄患者62例,对其中24例实施球囊扩张支架治疗,38例实施自膨式支架治疗.按Mori分型观察两组患者残留狭窄率及围手术期并发症情况.结果 ①对62例患者全部成功进行了血管内支架置入术,其中球囊扩张组术后的血管狭窄率从术前的(83±8)％降至术后即刻的(10±5)％,自膨式支架组术后狭窄率从术前的(81±11)％降至术后即刻的(17±10)％.②球囊扩张组24例患者中,有7例(29.2％)出现围手术期并发症,自膨支架组有4例(10.5％)患者出现并发症,差异无统计学意义,P =0.061.但若剔除手术操作因素,仅比较支架相关缺血并发症,显示自膨式支架组并发症的发生率(2/38,5.3％)明显低于球囊扩张组(7/24,29.2％),差异有统计学意义,P=0.022.从病变特点观察,显示MoriC型的患者具有较高的并发症的发生率.结论 在症状性基底动脉狭窄的治疗中,自膨式支架较球囊扩张支架围手术期并发症的发生率低,但术后残余狭窄率,白膨式支架比球囊扩张支架高.%Objective To investigate the perioperative complications of balloon expandable stent and self-expanding stent (Wingspan stent) in the treatment of patients with symptomatic basilar artery stenosis. Methods Sixty-two patients with symptomatic basilar artery stenosis admitted to the Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University from November 2006 to June 2011 were analyzed retrospectively. Twenty-four of them were treated with the balloon expandable stent and 38 were treated with the self-expanding stent. The residual stenosis rate and perioperative complications in patients of both groups were observed. Results①Endovascular stenting was performed successfully in all the 62 patients. Among them, the stenotic rate from 83 ±8% decreased to 10 ±5% immediately after procedure in the balloon expandable stent group. The stenotic rate from 81 ±11% decreased to 17 ± 10% immediately after procedure in the self-expanding stent group.②Seven (29. 2% ) of the 24 patients had perioperative complications in the balloon expandable stent group and 4 ( 10. 5% ) in the serf-expanding stent group. The difference was not statistically significant (P =0. 061). However, if excluding the surgical factors , only comparing the stent-related ischemic complications, it showed that the incidence of complications (2/38, 5.3% ) in the self-expanding stent group was significantly lower than that (7/24, 29.2% ) in theballoon expandable stent group. The difference was statistically significant ( P = 0. 022 ) . Observing from the pathological standpoint, it showed that the patients of Mori C type has higher incidence of complications. Conclusion Compared to the balloon expandable stent, the self-expanding stent has a lower incidence of perioperative complications in the treatment of symptomatic basilar arterial stenosis, but the postoperative residual stenosis of the self-expanding stent is higher.
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