Dabus Guilherme, Gerstle Ronald J, Derdeyn Colin P, Cross Dewitte T, Moran Christopher J
Division of Interventional Neuroradiology, Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital, Washington University School of Medicine, P.O. Box 8131, 510 S. Kingshighway Boulevard, St. Louis, MO 63110, USA.
Neuroradiology. 2006 Dec;48(12):917-23. doi: 10.1007/s00234-006-0151-7. Epub 2006 Nov 4.
We report our experience with the endovascular treatment of the vertebral artery origin in patients presenting with symptomatic vertebrobasilar ischemia and compare our results with those reported in the literature.
In 25 patients, 28 procedures were performed. Patients presented with posterior circulation ischemic symptoms despite optimal medical therapy with antiplatelet drugs and had a digital subtraction angiogram demonstrating stenosis of the origin of the vertebral artery greater than 50%. Retrospective review of the medical records, clinical notes and radiologic-procedural reports was performed.
Of the 25 patients, 18 were male and 7 female. Their ages ranged from 50 to 84 years. In 23 of the 25 patients the contralateral vertebral artery was occluded, hypoplastic, absent, or had greater than 50% stenosis. In 13 of the 25 patients angiographic evidence of significant anterior circulation disease was demonstrated. In 18 of the 25 patients the left vertebral artery was affected. The mean stenosis was 82.6%. Follow-up records were available in 19 patients. The mean follow-up was 24 months. Five of the 19 patients had recurrent symptoms of vertebrobasilar ischemia and three patients were retreated. Of the 28 procedures performed, 23 were angioplasty/stenting and 5 were angioplasties alone. Overall technical success was achieved in 26 of the 28 procedures (92.8%). No procedure-related transient ischemic attack, stroke or death was noted.
Endovascular treatment of the vertebral artery origin in this patient population is feasible, safe, and effective. There are some questions regarding the long-term follow-up and rate of restenosis and clinical recurrences that are yet to be answered.
我们报告了对有症状的椎基底动脉缺血患者进行椎动脉起始部血管内治疗的经验，并将我们的结果与文献报道的结果进行比较。
对25例患者进行了28次手术。尽管使用抗血小板药物进行了最佳药物治疗，但患者仍出现后循环缺血症状，数字减影血管造影显示椎动脉起始部狭窄大于50%。对病历、临床记录和放射学手术报告进行了回顾性分析。
25例患者中，男性18例，女性7例。年龄范围为50至84岁。25例患者中有23例对侧椎动脉闭塞、发育不全、缺如或狭窄大于50%。25例患者中有13例有明显前循环疾病的血管造影证据。25例患者中有18例左侧椎动脉受累。平均狭窄率为82.6%。19例患者有随访记录。平均随访时间为24个月。19例患者中有5例出现椎基底动脉缺血复发症状，3例患者再次接受治疗。在进行的28次手术中，23次为血管成形术/支架置入术，5次为单纯血管成形术。28次手术中有26次（92.8%）取得了总体技术成功。未发现与手术相关的短暂性脑缺血发作、中风或死亡。
对该患者群体进行椎动脉起始部血管内治疗是可行、安全且有效的。关于长期随访、再狭窄率和临床复发率仍有一些问题有待解答。
