椎动脉颅内段支架成形术后穿支动脉闭塞的临床研究

摘要： 目的 探索减少椎动脉颅内段支架术后发生穿支动脉闭塞的方法。方法 回顾性分析 32 例应用 Gateway-Wingspan 支架成形术治疗椎动脉颅内段重度狭窄的患者的临床资料， 评价术后狭窄改善程度及灌注改善情况， 分析发生穿支动脉闭塞的原因。结果 32 例患者共置入 33 枚 Wingspan 支架， 1 枚 Apollo 支架， 手术成功率 100%。术后患者椎动脉颅内段狭窄率由 （76.6±6.1） %降至 （27.9±5.2） %。术后 3 个月复查经颅多普勒超声 （TCD） 或头 CT 血管成像， 均未出现支架内再狭窄。术后 24 h 内 2 例患者发生延髓穿支动脉闭塞， 考虑其原因可能为狭窄处粥样硬化斑块稳定性下降， 术中球囊与支架的机械作用下导致斑块位移， 进而堵塞延髓动脉； 经过药物及康复治疗后， 症状改善明显。结论 椎动脉颅内段支架术后穿支动脉的闭塞可通过术前严格的评估与准备、 术中对球囊及支架的正确选择等措施来预防， 但仍需大样本数据的论证。

A clinical study of perforating artery occlusion occurring after stent implantation of intracranial branch of vertebral artery

Abstract： Objective To explore the methods to reduce the occlusion of perforating arteries after intracranial stenting of the vertebral artery. Methods Clinical data of 32 cases of Gateway-Wingspan stent implantation for intracranial branch of vertebral artery were retrospectively analyzed. The postoperative stricture and perfusion improvement situation were evaluated, the reason of perforating artery occlusion was analyzed. Results Thirty-two patients were implanted with 33 pieces of Wingspan stent and 1 piece of Apollo bracket. The operation success rate were 100%, and the stenosis rate reduced from (76.6±6.1)% to (27.9±5.2)%. After three months, the transcranial doppler sonography (TCD) and CT angiography were checked, showing no in- stent restenosis in all patients. Two patients occurred the perforating artery occlusion within 24 hours after operation. The possible reason was the change of stability of atherosclerotic plaque at the stenosis and the plaque displacement caused by the mechanical action of the balloon or stent, which may lead to medulla oblongata artery block. After drug and rehabilitation treatment, the symptoms in patients were improved significantly. Conclusion The perforating artery occlusion after stent implantation in intracranial branch of vertebral artery can be prevented by strict evaluation and preoperative preparation, the right selection of intraoperative balloon and stent, which still needs larger sample data to prove.