经皮血管成形术治疗症状性颅内椎-基底动脉狭窄的临床研究

目的探讨采用血管成形术治疗症状性颅内椎-基底动脉狭窄的预后及疗效。方法回顾性分析2002年9月—2007年3月采用血管成形术治疗的症状性颅内椎-基底动脉狭窄患者（狭窄率≥50%）,共112例（116处）,其中椎动脉颅内段狭窄68处,基底动脉狭窄48处。评估术后即刻治疗效果,手术成功率、并发症及病死率。术后每3个月行临床及影像学随访1次,评估卒中发生、症状改变情况及再狭窄情况。结果①114处成功置入支架,2处因椎动脉颅内段极度迂曲,支架无法到位,采用单纯球囊扩张成形术。114处中,78处管径恢复正常,34处残余狭窄率〈10%,4处残余狭窄率约为30%。血管狭窄率由术前的（84±8）%,下降至术后的（8±7）%,P〈0.01。②术后1周,6例（5.4%）患者出现与手术有关的并发症,其中急性血栓形成1例,穿支动脉闭塞3例,症状性颅内出血2例;死亡2例（1.8%）。③64例患者获得3～54个月的随访,平均（18±11）个月。其中2例（3.1%）死亡,8例（12.5%）发生再狭窄（复查DSA,再狭窄率为50%～90%）。结论采用血管成形术治疗症状性颅内椎-基底动脉狭窄是安全有效的,经短中期随访其疗效满意。

Percutaneous transluminal angioplasty for symptomatic intracranial vertebrobasilar artery stenosis: a clinical study

Objective To investigate the prognosis and efficacy of percutaneous transluminal angio- plasty in the treatment of symptomatic intracranial vertebrobasilar artery stenosis. Methods A total of 112 consecutive patients （116 stenosis totally, 68 stenosis in the intracranial segments of vertebral arteries, and 48 in the vertebrobasilar arteries ） with symptomatic intracranial vertebrobasilar artery stenosis （ 〉 50% ） treated with stent or balloon angioplasty from September 2002 to March 2007 were analyzed retrospectively. The immediate efficacy, success rate of operation, complications, and mortality were evaluated after the procedures. Clinical and imaging follow-up study were performed every 3 months after the procedures for assessment about the attack of stroke, the changes of clinical symptom, and the rate of restenosis. Results （1）Stent implantation was successfully performed in 114 stenosis, and two were failed due to extreme tortuosity of the intracranial segments of verlebral arteries, and balloon angioplasty plasty was used. The rate of technical success was 98.3%; 78 stenosis returned to normal, 34 had remnant ste- nosis less than 10% , and 4 had remnant stenosis about 30%. The rate of stenosis decreased from 84 ±8% before the procedure to 8 -7% after the procedure （P 〈0.01 ）. （2）Six patients （5.4%） experienced operation-related complications one week after the procedure, among them, one had acute thrombosis, 3 had perfo- rating artery occlusion, 2 had intraeranial hemorrhage and 2 patients died （ 1.8% ）. （3） 3 to 54 months （mean 18 months） follow-up study was achieved in 64 patients. Two patients （3.1%） died; 8 patients oc- curred restenosis, the rate of rcstenosis was 50 to 90%. Conclusion Percutaneous transluminal angioplasty for the treatment of symptomatic intracranial vertebrobasilar artery stenosis is safe and effective.