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亚急性及慢性椎动脉和基底动脉闭塞支架再通治疗的初步研究河南省人民医院介入科李天晓

贺迎坤 王子亮 李天晓 薛绛宇 白卫星 朱良付 李立 李钊硕

目的评价亚急性及慢性椎、基底动脉闭塞腔内支架再开通的可行性、安全性及疗效。方法21例优势侧椎动脉颅内段、基底动脉闭塞患者行腔内支架开通，记录围手术期并发症、随访时再发事件发生情况，手术前后对患者进行改良Rankin量表（mRS）评分和心肌梗死溶栓试验（TIMI）血流分级评估，统计学分析采用Wilcoxon秩和检验和Fisher确切概率法，数据以中位数（肘）和四分位数（侬）表示。结果21例患者20例闭塞动脉（95．2％）成功开通。术后评估，9例患者病情改善，10例稳定，2例恶化。闭塞远端中位TIMI血流分级由术前的0（IR0―1）提升到术后的3（IR 3～3），差异有统计学意义（Z=4．091，P〈0．01）。中位mRS评分术前为4．0（IR2．5―5．0），出院时为4（IR1．0―5．0），差异有统计学意义（Z=2．810，P〈0．01）；围手术期并发症3例，1例基底动脉夹层，1例支架内血栓形成，1例术后急性闭塞。术后30d内无患者死亡、再发卒中及短暂性脑缺血发作等事件发生。21例患者临床平均随访7个月，1例出现短暂性脑缺血发作，1例再发卒中，2例死于系统性并发症。所有患者中位mRS评分为2．0（IR1．0―4．0），而19例生存患者的中位mRS评分为1．0（IR1．0～4．0）。结论亚急性慢性椎基动脉闭塞腔内支架成形再通在技术上是可行的，能够预防反复缺血事件的发生，促进患者残疾功能的恢复。但其确切疗效还有待大样本长期随访研究证实。 Objective To evaluate the technical feasibility, safety and treatment effect of endovascular revascularization of symptomatic sub-acute and chronic intracranial vertebrobasilar artery occlusion. Methods Twenty-one consecutive patients with symptomatic sub-acute and chronic intracranial vertebrobasilar occlusion underwent endovascular revascularization. Perioperative complications and recurrent events during the follow-up period were recorded. The modified Rankin scale （mRS） scores and blood stream thrombolysis in myocardial infarction （TIMI） scores for all patients preoperatively, postoperatively and at follow-up were evaluated. The results were analyzed using Wilcoxon rank sum test and Fisher exact test. Results All 21 patients but 1 （95.2%, 20/21 ） obtained successful recanalization. After the procedure, 9 patients showed improvements, 10 were stable, and 2 worse. The decline of median mRS scores, which was 4 preoperatively [ inter-quartile range （ IR ） 2. 5--5.0 1 and 4 （ IR 1.0--5.0 ） on discharge from the hospital respectively, showed significant statistical difference （ Z = 2. 810, P 〈 0. 01 ）. Three （ 14. 3% ） patients suffered periproeedural complications, namely basal arterial dissection, intra-stent thrombosis and postoperatively acute occlusion in each one. There was no death, stoke or recurrent transient ischemic attack （TIA） occurring 30 days after the procedure. During the 7 months after operation, which was the mean clinical follow-up duration, TIA and recurrent stoke occurred in one patient respectively, and two patients died of systemic complications. The median mRS scores were 2. 0 （ IR 1.0---4. 0 ） in all 21 patients and 1 （IR 1.0---4. 0） in the surviving subjects. Conclusions Endovascular revascularization for the recanalization of symptomatic sub-acute and chronic vertebrobasilar artery occlusion is technically feasible, and helps to prevent ischemic events and improve disability recovery. However, its exact effect needs further verification by future random controlled studies.