支架置入与药物治疗椎动脉起始部狭窄的疗效观察

摘要： 目的 对比支架置入与药物治疗椎动脉起始部狭窄的疗效。方法 将 76 例椎动脉起始部狭窄患者分为支架组 （40 例） 和药物组 （36 例）， 分别给予支架置入及药物治疗， 观察支架组患者围手术期 （术后 30 d） 并发症发生率及再狭窄率。记录 2 组在 3 个月、 6 个月、 12 个月时后循环缺血症状再发情况以及 12 个月时 2 组患者病变血管狭窄程度的变化。结果 支架组 40 例患者共置入支架 43 枚， 手术成功率 100%， 围手术期并发症发生率 12.5%； 支架组患者术后即刻血管狭窄程度从 （80.36±6.42） %降至 （18.21±5.92） %； 12 个月后支架组血管狭窄率为 （22.82± 9.80） %， 与术后即刻比较差异无统计学意义 （P＞0.05）， 而药物组治疗前、 后的血管狭窄率分别为 （79.98±5.76） %、（83.42±9.53） %， 差异无统计学意义 （P＞0.05）； 治疗前支架组血管狭窄率与药物组差异无统计学意义 （P＞0.05）， 治疗 12 个月后明显低于药物组 （P＜0.05）； 随访期间支架组、 药物组分别有 4 例 （10%）、 10 例 （27.8%） 发生后循环缺血事件， 支架组明显低于药物组 （P＜0.05）。结论 支架置入治疗椎动脉起始部狭窄安全、 有效， 其预防后循环缺血事件的疗效优于单纯药物治疗。

Clinical observation of the stenting and medication for vertebral artery origin stenosis

Abstract: Objective To compare the efficacy between stenting and medication in patients with vertebral artery origin stenosis. Methods Seventy-six patients with vertebral artery origin stenosis were divided into stent group (n=40) and medication group (n=36). The incidences of complications in the perioperative period (30 days after surgery), and the rates of cerebral ischemic events after 3 months, 6 months and 12 months were recorded in two groups. The changes of vascular stenosis after 12 months were also observed in two groups. Results Forty-three stents were implanted in 40 patients. The operation success rate was 100%, and perioperative complication rate was 12.5%. The vascular stenosis rate was decreased from (80.36±6.42) % to (18.21±5.92)% after operation in the stent group, and increased to (22.82± 9.80)% after 12 months. There was no significant difference in the vascular stenosis rate between postoperative instant and 12 months after operation (P＞0.05). The vascular stenosis rate was increased from (79.98±5.76)% to (83.42±9.53)% after treatment in the medication group but no statistical significance in the difference (P＞0.05). There was no significant difference in the vascular stenosis rate between the stent group and the medication group before treatment, but which was significantly lower in the stent group than that of the medication group after 12-month treatment (P＜0.05). There were four cases (10%) of ischemic events in the stent group and 10 cases (27.8%) in the medication group during the follow-up period. The ischemic events were significantly lower in the stent group than those of the medication group (P＜0.05). Conclusion Stenting is safe and effective for patients with vertebral artery origin stenosis, which is better than medication for preventing the occurrence of the posterior circulation ischemic events.