CAJ | 학술논문

目的：探讨置入单枚自膨式支架同时治疗椎动脉起始部合并邻近锁骨下动脉狭窄的技术可行性和疗效。方法采用单枚支架置入同时治疗有后循环缺血症状的椎动脉起始部狭窄（狭窄率≥70％）合并邻近锁骨下动脉狭窄（狭窄率≥50％）的患者21例。术中将1枚自膨式开环支架的头端放置于椎动脉V1段的中远端，尾端放置于锁骨下动脉的近端。术后6～12个月行CT血管成像（CTA）和（或）DSA随访。回顾性分析患者的临床和影像资料。结果全部支架成功置入，椎动脉平均狭窄率由术前（87.1±5.7）％降至（7.4±6.4）％（中位数5％，范围0％～20％），锁骨下动脉狭窄率由（61.9±8.4）％降至（4.5±5.7）％（中位数0％，范围0％～20％），差异均有统计学意义（均P＜0.05）；无围手术期并发症发生。随访中发现1例（4.8％）患者椎动脉支架内再狭窄（狭窄率约50％），但无相关临床症状；1例（4.8％）术后6个月再发眩晕，复查CTA和DSA，显示支架压缩合并椎动脉闭塞。结论单枚自膨式支架置入同时治疗椎动脉起始部合并邻近锁骨下动脉狭窄，技术可行且安全，支架内再狭窄和支架压缩的发生率较低。
목적：탐토치입단매자팽식지가동시치료추동맥기시부합병린근쇄골하동맥협착적기술가행성화료효。방법채용단매지가치입동시치료유후순배결혈증상적추동맥기시부협착（협착솔≥70％）합병린근쇄골하동맥협착（협착솔≥50％）적환자21례。술중장1매자팽식개배지가적두단방치우추동맥V1단적중원단，미단방치우쇄골하동맥적근단。술후6～12개월행CT혈관성상（CTA）화（혹）DSA수방。회고성분석환자적림상화영상자료。결과전부지가성공치입，추동맥평균협착솔유술전（87.1±5.7）％강지（7.4±6.4）％（중위수5％，범위0％～20％），쇄골하동맥협착솔유（61.9±8.4）％강지（4.5±5.7）％（중위수0％，범위0％～20％），차이균유통계학의의（균P＜0.05）；무위수술기병발증발생。수방중발현1례（4.8％）환자추동맥지가내재협착（협착솔약50％），단무상관림상증상；1례（4.8％）술후6개월재발현훈，복사CTA화DSA，현시지가압축합병추동맥폐새。결론단매자팽식지가치입동시치료추동맥기시부합병린근쇄골하동맥협착，기술가행차안전，지가내재협착화지가압축적발생솔교저。
Objective Toinvestigatethetechnicalfeasibilityandefficacyofvertebralarteryorigin and adjacent subclavian artery stenosis treated with a single self-expandable stent implantation simultaneously. Methods Twenty-onepatientswithposteriorcirculationischemicsymptomsweretreatedwithasingle stent implantation for vertebral artery origin (stenosis rate≥70%)and adjacent subclavian artery stenosis (stenosis rate ≥50%)simultaneously. The head end of a single self-expandable open-cell stent was implanted into the middle or distal V1 segment of vertebral artery,and the caudal end was implanted at the proximal subclavian artery during procedure. At 6 -12 months after procedure they received followed-up with CTA and/or DSA. The clinical and image data of the patients were analyzed retrospectively. Results Allstentswereimplantedsuccessfully.Thevertebralarterystenosisratewasdecreasedfrom 87. 1 ± 5. 7% before procedure to 7. 4 ± 6. 4% and the subclavian artery stenosis rate was decreased from 61.9±8.4% to4.5±5.7% aftertheprocedure.Therewassignificantdifference(allP<0.05).No perioperative complications occurred. The in-stent restenosis (about 50%) was found in one patient (4.8%)during the follow-up and he did not have any relevant clinical symptoms. One patient (4. 8%) had recurrent vertigo at 6 months after procedure. CTA and DSA examinations revealed stent compression and vertebralarteryocclusion.Conclusion Asingleself-expandablestentimplantationforthetreatmentof vertebral artery origin and adjacent subclavian artery stenosis simultaneously is feasible and safe. The incidences of in-stent stenosis and stent compression are low.