Cloud G C, Crawley F, Clifton A, McCabe D J H, Brown M M, Markus H S
Division of Clinical Neuroscience, St George's Hospital Medical School, London SW17 0RE, UK.
J Neurol Neurosurg Psychiatry. 2003 May;74(5):586-90. doi: 10.1136/jnnp.74.5.586.
To report a single centre ongoing experience of endovascular treatment for atherosclerotic vertebral artery origin stenosis in a series of symptomatic patients, with follow up imaging to determine the incidence of restenosis.
14 patients with vertebral artery origin stenosis on catheter angiography were treated. Angioplasty without stenting was undertaken in the first four patients, all of whom had follow up catheter angiography at one year. Subsequently, patients were treated by primary stenting and followed up with colour Doppler ultrasound examination.
The procedure was technically successful in all treated arteries, with no immediate complications. The degree of stenosis was reduced from (mean (SD)) 73 (18)% before treatment to 21 (26)% immediately after treatment in the angioplasty alone group (p = 0.059). In the primary stenting patients, the severity of stenosis was reduced from 82 (8)% to 13 (13)% immediately after treatment (p < 0.001). Restenosis to 70% or greater occurred at one year in all four patients initially treated by angioplasty without stenting. One patient subsequently developed further symptoms and was retreated by stenting. One of the 10 patients treated by primary stenting developed restenosis. None of the remaining patients had further posterior circulation ischaemic symptoms during a mean follow up period of 33.6 months (range 1 to 72 months).
Restenosis occurs often after vertebral artery origin balloon angioplasty without stenting but is uncommon after stenting. Primary stenting is therefore recommended to maintain patency at this site, and had a low complication rate in this series.
报告在一系列有症状患者中，单中心对动脉粥样硬化性椎动脉起始部狭窄进行血管内治疗的持续经验，并通过随访成像确定再狭窄的发生率。
对14例经导管血管造影显示椎动脉起始部狭窄的患者进行了治疗。前4例患者接受了单纯血管成形术，所有患者均在1年后接受了随访导管血管造影。随后，对患者进行了初次支架置入治疗，并采用彩色多普勒超声检查进行随访。
所有治疗的动脉在技术上均获成功，无即刻并发症。单纯血管成形术组狭窄程度从治疗前的平均（标准差）73（18）%降至治疗后即刻的21（26）%（p = 0.059）。在初次支架置入患者中，狭窄严重程度从82（8）%降至治疗后即刻的13（13）%（p < 0.001）。最初接受单纯血管成形术治疗的4例患者在1年时均出现了70%或更高程度的再狭窄。1例患者随后出现了进一步症状，并再次接受了支架置入治疗。在接受初次支架置入治疗的10例患者中，有1例出现了再狭窄。在平均33.6个月（范围1至72个月）的随访期内，其余患者均未出现进一步的后循环缺血症状。
椎动脉起始部球囊血管成形术（未置入支架）后再狭窄常见，但支架置入后不常见。因此，建议在该部位进行初次支架置入以维持通畅，且在本系列中并发症发生率较低。
