经皮腔内血管成形和支架植入术治疗椎基底动脉狭窄

目的　探讨经皮腔内血管成形和支架植入术治疗椎基底动脉狭窄的效果和安全性。方法　 2 0 0 3年 4月至 2 0 0 4年 6月间 ,2 8例椎基底动脉狭窄患者进行了经皮腔内血管成形和支架植入术治疗。结果　 2 8例患者 ,18例为优势侧椎动脉狭窄 ,4例为双侧椎动脉狭窄 ,3例为一侧椎动脉狭窄、对侧椎动脉闭塞 ,1例为串联狭窄 ,2例为基底动脉狭窄。狭窄段位于椎动脉开口 7例 ,位于颈部椎动脉 2例 ,位于颅内段 17例。MoriA型病变 2 4例 ,B型病变 3例 ,C型病变 1例。全组技术成功率 10 0 % ,术前2 8例平均狭窄率为 81.3% ,术后残余狭窄率均 <10 % ,(P <0 .0 1)。所有病例在围手术期内均未发生严重并发症。本组随访 17例患者 ,时间为 6个月 ,Malek评分为 1分者 15例 ,2分者 2例。DSA脑血管造影复查 3例均未见支架内再狭窄。结论　经皮腔内血管成形和支架植入术是治疗椎基底动脉供血不足 ,预防椎基底动脉系统卒中的安全、有效方法 ;近期预后良好

The percutaneous transluminal angioplasty and stenting for the vertebrobasilar stenosis

Objective To investigate the effectiveness, safety of the percutaneous transluminal angioplasty and stenting (PTAS) in the management of the vertebrobasilar stenosis.Methods From April 2003 through June 2004, the PTAS was performed in 28 patients with the vertebrobasilar stenosis. Results Among the 28 patients, the unilateral significant stenosis of the dominant vertebral artery was found in 18 patients, the bilateral stenosis of the vertebral artery in 4 patients, the tandem stenosis of the vertebral artery in 1 patient, the stenosis of the basilar artery in 2 patients. According to Mori's division, the type A occurred in 24 patients, the type B in 3 patients, the type C in 1 patient. The successful rate of stent implantation was 100% without any serious complication. Twenty-eight patients underwent PTAS with a mean preprocedural vertebrobasilar stenosis of 81.3%. The residual stenosis was less than 10%. Over a mean 6-month follow-up in 17 patients, according to Malek's scale, the scale 1 was in 15 patients, the scale 2 in 2 patients. No restenosis was in 3 patients by the cerebral angiography.Conclusions Preliminary results show that PTAS in the management of the vertebrobasilar stenosis is a safe and effective method. Meanwhile, PTAS may alleviate the vertebrobasilar ischemia despite best medical management and prevent stroke of the vertebrobasilar system.