血管内支架置入术与最佳药物治疗症状性椎动脉颅内段狭窄的比较研究

目的研究血管内支架置入治疗症状性椎动脉颅内段狭窄的长期疗效是否优于单纯药物治疗。方法选择101例椎动脉颅内段粥样硬化性重度狭窄(≥70%)患者,分为支架置入组47例和药物治疗组54例。比较2组患者围手术期并发症、再发脑血管事件、死亡及神经功能恢复等长期随访结果。结果 2组患者平均随访(23.3±19.9)个月。支架置入组发生主要终点事件6例(12.8%),药物治疗组10例(18.5%,HR=2.65,95%CI:0.84～8.33,P=0.095)。2组30 d内主要终点事件发生率比较,差异无统计学意义(P=0.247);但30 d至随访结束的累积终点事件发生率差异有统计学意义(HR=0.23,95%CI:0.07～0.81,P=0.022)。支架置入组临床预后良好的比例明显高于药物治疗组(95.7%vs 87.0%,P=0.021)。结论椎动脉颅内段成功置入支架对脑卒中预防效果优于药物治疗,其可改善患者神经功能预后。

Endovascular stenting and optimal drug treatment of symptomatic intracranial vertebral artery atherosclerotic stenosis

Objective To study whether the long-term curative effect of endovascular stenting is better than that of simple drug treatment on symptomatic intracranial vertebral artery atherosclerotic stenosis(≥70%).Methods One hundred and one patients with symptomatic intracranial vertebral artery atherosclerotic stenosis were divided into stenting group(n = 47) and drug treatment group(n=54).Follow-up data,such as perioperative complications,recurrence of cerebrovascular events,death,recovery of nerve function,were compared between the two groups.Results The patients were followed up for 23.3+19.9 months.Primary end point events occurred in 6 patients (12.8%) of stenting group and in 10 patients(18.5%) of drug treatment group(HR=2.65, 95%CI:0.84—8.33,P = 0.095).However,a significant difference was found in the incidence of accumulative end point events between the two groups from day 30 to the end of follow-up(HR= 0.23,95%CI:0.07—0.81,P = 0.022).The proportion of improved clinical symptoms was significantly higher in stenting group than in drug treatment group(95.7%vs 87.0%,P = 0.021).Conclusion The effect of stenting is advantageous over that of drug treatment for preventing stroke in patients with intracranial arterial stenosis of vertebral artery,and can thus improve the recovery of their nerve function.