血管支架成形术在颅内椎-基底动脉狭窄中的临床应用

目的探讨经皮血管支架成形术治疗椎动脉颅内段和基底动脉狭窄。方法对24例椎动脉颅内段和基底动脉狭窄患者进行血管造影，行经皮血管内支架置入术，并根据患者血管狭窄程度给予预扩张或后扩张。结果24例患者椎动脉狭窄和基底动脉狭窄的狭窄率从术前平均84％下降到24％，术后均没有缺血性卒中发作。随访13个月，22例患者临床症状消失，2例患者遗有永久性神经功能障碍，其中1例与手术有关，1例与颅内血管远端病变有关。结论椎动脉颅内段和基底动脉狭窄患者，内科治疗无效时，经皮血管内支架置人术可以缓解椎-基底动脉狭窄患者缺血症状，预防卒中再发生。

Angioplasty and stenting for intracranial vertebrobasilar arterial stenosis

Objective To report the preliminary experience of percutaneous transluminal angioplasty and stenting(PTAS) in treating intracranial vertebral artery (VA) and basilar artery (BA) stenosis. Methods 24 patients with intracranial vertebrobasilar arterial stenosis were managed from December 2001 to April 2003. 16 cases were male and 8 cases were female. Their age was ranging from 49 to 72 years old, mean age was 64 years-old. The patients included 18 cases of VA stenosis and 6 cases of BA stenosis. All patients presented with the symptom of vertebrobasilar ischemia (VBI),and antiplatelet and anticoagulant therapy showed no effect. Results All patients underwent PTAS with mean preoperative stenosis of 84% (ranging from 50% to 99%) that was reduced to 24% (ranging from 0% to 25%) after PTAS. There were no ischemic stroke occurred postoperatively. Patients were followed by clinical evaluation and personal or telephone interviews. Over a mean 13-months (ranging from 6 to 22 months) follow-up, 22 (92%) patients remained asymptomatic, while 2 (8%) patients had permanent deficits.1 of them was related to the operation and 1 case was owing to distal vascular disease. Conclusion Intracranial VA or BA angioplasty and stenting can alleviate the ischemic symptoms of patients with vertebrobasilar stenosis when the patients failed to respond to the best medical management and may prevent recurrence of ischemic attack.