Apollo支架治疗椎动脉起始部和颅内段狭窄的疗效比较

目的比较Apollo支架治疗椎动脉起始部和颅内段狭窄的安全性和有效性。方法回顾性分析河南省人民医院介入科2010年1月—2011年12月使用Apollo支架治疗椎动脉单发狭窄103例患者的资料,共103处狭窄,根据狭窄部位分为椎动脉起始部组(33例)和椎动脉颅内段组(70例)。比较两组患者的临床预后、再狭窄率及并发症。结果①支架到位率为100%。术后即刻造影显示,残余狭窄率<10%的有86处,其余16处的残余狭窄率均<20%,1处因出血用弹簧圈闭塞。②有3例在围手术期出现并发症,占2.9%(3/103),其中1例并发脑出血,2例并发脑梗死,均为椎动脉颅内段组患者。椎动脉起始部组并发症的发生率(0/33)与颅内段组(3/70)比较,差异无统计学意义,P=0.549。③术后6个月影像学随访67例,其中13例发生支架内再狭窄,椎动脉起始部组再狭窄的发生率(32.1%,9/28)高于颅内段组(10.3%,4/39),差异有统计学意义,P=0.025。④术后临床随访94例,平均9个月,无死亡病例。有8例再次发生后循环脑梗死,其中椎动脉起始部组3例(3/30,10.0%),颅内段组5例(5/64,7.8%),两组比较差异无统计学意义。结论 Apollo支架治疗椎动脉狭窄是安全、有效的。椎动脉颅内段组围手术期并发症的发生率高于起始部组,而椎动脉起始部组再狭窄的发生率高于颅内段组。

Efficacy comparison of the treatment of vertebral artery ostium and intracranial vertebral arterystenosis with Apollo stents

Objective To compare the safety and efficacy of Apollo stents in the treatment of vertebral artery ostium and intracranial vertebral artery stenosis. Methods A total of 103 patients with single vertebral artery stenosis treated with Apollo stents at the department of interventional radiology, Henan Provincial People＇s Hospital from January 2010 to December 2011 were analyzed retrospectively. The patients were divided into either a vertebral artery ostium group （ n = 33 ） and an intracranial vertebral artery group （ n = 70） according to the sites of stenosis. The clinical prognosis, instent restenosis rate and complications in both groups were compared. Results ①The stent in place rate was 100% and the technical success rate was 100%. Immediate postoperative angiography showed that the residual stenosis was 〈 10% in 86 sites and the residual stenosis rate was 〈 20% in the remaining 16 sites. 1 case was obliterated by stent because of Bleeding. ② Three patients had perioperative complications, accounting for 2.9% （ 3/103 ） , 1 of them complicated cerebral hemorrhage and 2 complicated infarctions. They were all in the intraeranial vertebral artery group. There was no significant difference in the complication rate between the vertebral artery ostium group （0/33） and the intracranial vertebral artery group （ 3/70 ） （ P = 0. 549 ）. ③Sixty seven patients were followed up with imaging at 6 months after procedure, 13 of them occurred in-stent restenosis,and the restenosis rate （32.1% ,9/28 ） in vertebral artery ostium group was higher than that in the intraera- nial vertebral artery group （10.3% ,4/39）. The difference was statistically significant （P = 0. 025 ）. （~） Ninety four patients were clinically followed up for a mean of 9 months no mortality oecurred. A total of 8 patients oeeurred posterior eireulation cerebral infarction again, among them 3 were in the vertebral ostium group （3/30,10.0%） and 5 were in the intraeranial vertebral artery group （5/64,7.8%）. There was no significant differenee between the two groups. Conclusion The Apollo stent is safe and effective in the treatment of vertebral artery stenosis. The perioperative eomplieation rate is higher in the intraeranial vertebral artery group, but the restenosis rate is higher in the vertebral artery ostium group.