支架成形术治疗老年症状性颅内椎动脉粥样硬化性重度狭窄长期随访结果

摘要

Objective To assess the safety and efficacy of stenting angioplasty for elderly patients with severe symptomatic intracranial vertebral artery atherosclerotic stenosis during the long-term follow-up period.Methods Forty elderly patients with severe symptomatic intracranial vertebral artery atherosclerotic stenosis admitted to our hospital for stenting angioplasty were included in this study.Six months after they underwent multimodality imaging-guided stenting angioplasty,the instent restenosis was detected by DSA.The patients were followed up,during which perioperative ischemic stroke or death,receurrent ischemic stroke and stent restenosis were recorded.Results The operative success rate,preoperative and postoperative mean stenosis rate were 100％,82.3％ ±9.6％ and 23.3％ ±12.0％ respectively.No nervous system complication and death occurred.The patients were followed up for 3-64 (34.4± 18.5) months,during which serevere ischemic stroke occurred in 1 patient (2.5％) due to instent occlusion.Of the 25 patients (62.5％) who underwent DSA reexamination,instent restenosis occurred in 12 (48.0％) including 3 with instent occlusion.The rate of Enterprise instent restenosis was higher than that of Wingspan instent restenosis or Apollo instent restenosis.The incidence of instent restenosis was higher in patients with their residual stenosis rate ＞ 35％ than in those with their residual stenosis rate ＜35％ (P＞0.05).Conclusion Stenting angioplasty is safe and effective for elderly patients with severe symptomatic intracranial vertebral artery atherosclerotic stenosis.%目的 本研究通过长期随访评估支架成形术治疗老年症状性颅内推动脉粥样硬化性重度狭窄的安全性及有效性.方法 选择支架成形术治疗症状性颅内椎动脉粥样硬化性重度狭窄患者40例.采用多模态影像指导下的支架成形术治疗方法.术后6个月行数字减影血管造影术明确支架再狭窄情况.随访主要观察指标包括围术期任何脑卒中或死亡,随访期供血区脑卒中复发和支架再狭窄情况.结果 40例患者中,手术技术成功率100％,术前平均狭窄率为(82.3±9.6)％,术后平均狭窄率为(23.3±12.0)％.围术期无神经系统并发症和死亡.随访3～64(34.9±18.5)个月.随访期内因支架内闭塞发生严重供血区缺血性脑卒中1例(2.5％).接受数字减影血管造影术复查25例(62.5％),支架内再狭窄12例(48.0％),包括支架内闭塞3例.Enterprise支架内再狭窄率高于Wingspan支架及Apollo支架,但差异无统计学意义(71.4％ vs 38.5％、40.0％,P＞0.05).治疗后支架残余狭窄率＞35％的患者支架内再狭窄率高于残余狭窄率＜35％的患者,差异无统计学意义(75.0％ vs 42.9％,P＞0.05).结论 支架成形术治疗老年症状性颅内椎动脉粥样硬化性重度狭窄是安全、有效的.