CAJ | 학술논문

目的：探讨血管内支架置入术治疗症状性椎动脉开口处狭窄的手术疗效及安全性。方法回顾性纳入2010年11月-2013年1月中日友好医院神经内科收治的40例症状性椎动脉开口处狭窄且狭窄率≥70％的患者，所有患者接受血管内支架置入术治疗，其中置入金属裸支架15例，置入药物洗脱支架25例。分析患者手术技术成功率、围手术期并发症及症状缓解率，同时，在随访期内（13～36个月），观察支架血管供血区的卒中和死亡事件以及相关缺血症状并记录再狭窄率。结果对40例患者共置入42枚支架，技术成功率100．0％。椎动脉开口处术前狭窄率为75％～99％，平均（85±7）％；术后残余狭窄率为0～20％，平均（6±4）％。围手术期无并发症发生。随访期内19例临床症状完全消失，16例明显改善，症状缓解率87.5％。未发生支架血管供血区相关的卒中和死亡，4例发生后循环短暂性脑缺血发作；13例术后出现再狭窄，其中金属裸支架10例，药物洗脱支架3例，置入金属裸支架再狭窄发生率（10/15）与药物洗脱支架再狭窄发生率（3/25）差异有统计学意义（χ2＝12．771，P＝0.001）。结论血管内支架治疗症状性椎动脉开口处狭窄是一种安全有效的方法，虽然存在较高的再狭窄率，但能够有效改善后循环缺血症状。
목적：탐토혈관내지가치입술치료증상성추동맥개구처협착적수술료효급안전성。방법회고성납입2010년11월-2013년1월중일우호의원신경내과수치적40례증상성추동맥개구처협착차협착솔≥70％적환자，소유환자접수혈관내지가치입술치료，기중치입금속라지가15례，치입약물세탈지가25례。분석환자수술기술성공솔、위수술기병발증급증상완해솔，동시，재수방기내（13～36개월），관찰지가혈관공혈구적졸중화사망사건이급상관결혈증상병기록재협착솔。결과대40례환자공치입42매지가，기술성공솔100．0％。추동맥개구처술전협착솔위75％～99％，평균（85±7）％；술후잔여협착솔위0～20％，평균（6±4）％。위수술기무병발증발생。수방기내19례림상증상완전소실，16례명현개선，증상완해솔87.5％。미발생지가혈관공혈구상관적졸중화사망，4례발생후순배단잠성뇌결혈발작；13례술후출현재협착，기중금속라지가10례，약물세탈지가3례，치입금속라지가재협착발생솔（10/15）여약물세탈지가재협착발생솔（3/25）차이유통계학의의（χ2＝12．771，P＝0.001）。결론혈관내지가치료증상성추동맥개구처협착시일충안전유효적방법，수연존재교고적재협착솔，단능구유효개선후순배결혈증상。
Objective Toinvestigatetheoperativeeffectandsafetyofendovascularstentingfor thetreatmentofsymptomaticvertebralarteryostialstenosis.Methods Fortypatientswithsymptomatic vertebral artery ostial stenosis and stenosis rate ≥70% were admitted to the Department of Neurology, China-Japan Friendship Hospital from November 2010 to January 2013 were enrolled retrospectively. All patients received endovascular stenting therapy,15 of them were implanted bare metal stents,and 25 were implanted drug eluting stents. The technical successful rate of operation,perioperation complications,and symptom remission rate of the patients were analyzed. At the same time,stroke and death incident as well as the related ischemic symptoms of the stent vascular feeding area in the follow-up period (13 to 36 months)wereobservedandtherestenosisratewasdocumented.Results Atotalof42stentswereimplanted in 40 patients,and the technical success rate was 100. 0%. The preoperative stenosis rate of vertebral artery ostial stenosis was 75% to 99%(mean 85 ± 7%);the postoperative stenosis rate was 0% to 20%(mean 6 ± 4%). There was no perioperative complication. The clinical symptoms of 19 patients disappeared completely,16 were improved significantly within the follow-up period,and the symptom remission rate was 87. 5%. No stent vascular feeding area related stroke and death occurred. Four patients had transient ischemic attack in posterior circulation,13 had restenosis after procedure (10 of them with bare mental stents and 3 with drug eluting stents). There was significant difference in restenosis rate between the bare mental stents andthedrugelutingstents(10/15vs3/25,P=0.001).Conclusion Endovascularstentingforthe treatment of the severe symptomatic vertebral artery ostial stenosis is a safe and efficient method. Although its restenosis rate is high,but it can improve the symptom of posterior circulation ischemia effectively.