Objective: To evaluate the effect of stenting for proximal atherosclerotic extracranial vertebral artery stenosis. Methods: A total of 204 proximal atherosclerotic extracranial vertebral artery stenosis patients underwent stent implantation at Fuwai Hospital were enrolled consecutively between August 2007 and June 2014 prospectively. Medical records were collected and the clinical results were obtained through outpatient and telephone follow up. Results: (1) The patients were (64.1±7.9) years old, and 179 were male (87.7%). (2) Stent implantation was performed on 210 proximal atherosclerotic extracranial vertebral artery stenosis lesions with 210 stents (156 on the left, 54 on the right), and 6 patients received both sides stent implantations. Technical success rate was 100%(210/210). The stenosis of the lesions was decreased from (85.1±6.4) % to (6.5±3.2) % after the stent implantation (P<0.01). (3) Three (1.5%) patients experienced transient ischemic attack during the procedure, and two (1.0%) patients suffered from minor posterior circulation ischemic strokes on the 2nd and 10th day after the procedure, respectively. (4)The median follow-up was 1.5 (0.8-2.5) years. Three(1.5%) patients died (two non-vacular deaths, and the other one due to sudden cardiac death). Three (1.5%) patients developed stroke (one case ipsilateral posterior circulation stroke, and two cases unrelated area stroke). Four (2.0%) patients experienced transient ischemic attack. One patient suffered nonfatal myocardial infraction. In-stent restenosis occurred in thirty nine (19.4%) patients, of which fourteen (35.9%) patients were totally occluded and four (10.3%) patients with symptomatic restenosis. Kaplan-Meier survival curve showed that the primary patency rate of the vertebral artery were 85.6%, 78.6%, 72.2% and 64.4% at 1, 2, 3 and 5 years, respectively. Conclusions: Stenting for proximal atherosclerotic extracranial vertebral artery stenosis is safe and feasible, with a good middle to long-term patency rate. However, further trials are required to validate the effective results found in this patients cohort.
目的： 评价支架术治疗颅外椎动脉近端粥样硬化性狭窄的效果。 方法： 采用前瞻性研究方法，连续入选2007年8月至2014年6月在阜外医院行支架术的颅外椎动脉近端粥样硬化性狭窄住院患者204例。收集患者的临床资料，并进行门诊和电话随访。 结果： (1)患者年龄(64.1±7.9)岁，其中男性179例(87.7%)。(2)共处理颅外椎动脉近端粥样硬化性狭窄病变210处，其中左侧156处，右侧54处(其中6例患者行双侧椎动脉支架术)。置入支架210枚，支架术的技术成功率为100%(210/210)。术前椎动脉直径狭窄程度为(85.1±6.4)%，术后残余直径狭窄程度为(6.5±3.2)%，两者差异有统计学意义(P<0.01)。(3)3例(1.5%)患者术中出现短暂性脑缺血发作，2例(1.0%)患者分别于术后第2和10天出现后循环缺血性小卒中。(4)术后随访时间中位数为1.5 (0.8～2.5)年。3例(1.5%)患者死亡，其中非后循环相关死亡2例，心脏性猝死1例；卒中3例(1.5%)，其中支架侧后循环卒中1例，无关区域卒中2例；短暂性脑缺血发作4例(2.0%)；非致死性心肌梗死1例(0.5%)；支架内再狭窄39例(19.4%)，其中完全闭塞14例(35.9%)，症状性再狭窄4例(10.3%)。Kaplan－Meier生存曲线显示，支架置入后1、2、3和5年的原发性通畅率分别为85.6%、78.6%、72.2%和64.4%。 结论： 支架术治疗颅外椎动脉近端粥样硬化性狭窄安全、可行，中远期通畅率较高，但尚需进一步研究证实。.
Keywords: Atherosclerosis; Stents; Vertebrobasilar insufficiency.