Zavala-Alarcon Edgardo, Emmans Lisa, Cecena Felipe, Little Renee, Bant Ankur
Cardiology Department, Maricopa Medical Center, Phoenix, AZ 85008, USA.
Cardiovasc Revasc Med. 2007 Apr-Jun;8(2):107-13. doi: 10.1016/j.carrev.2006.11.004.
The purpose of this study was to evaluate the results of endovascular treatment of symptomatic vertebrobasilar insufficiency unresponsive to medical therapy.
Twenty-eight patients who were regularly followed up in our cardiology clinic with symptoms suggestive of posterior fossa ischemia and with diagnostic or suspicious findings on ultrasound evaluation were evaluated with selective vertebral and subclavian artery angiography. All patients (17 men, 11 women; mean age, 64 years; range, 54-87) had critical lesions (>70% stenosis) in the vertebral or subclavian arteries or both. Those lesions that were considered severe enough to explain the reported symptomatology underwent percutaneous intervention and stent placement. All patients were followed up through clinic visits for a mean of 14.2 months (range, 3.5-24.3).
In the 28 patients treated, 25 vertebral and 10 subclavian stents were placed. Success (<20% residual diameter stenosis, without stroke or death) was achieved in 27 patients (96%). One patient who had been undergoing intervention for a subtotal occlusion of the left subclavian artery developed a posterior fossa transient ischemic attack. At follow-up, 25 patients (89%) were alive, and 22 (88%) of those had no further neurological complaints. Three (11%) patients died during follow-up from cardiac complications. One (3.5%) patient had recurrent symptoms with in-stent restenosis at 6 months with successful balloon angioplasty and resolution of symptoms.
Posterior fossa ischemia is an underdiagnosed condition that occurs with relative frequency in the usual patient population that interventional cardiologists attend to. Endovascular treatment using coronary wires and stents including drug-eluting stents is the treatment of choice for vertebral artery revascularization due to its high technical success rate, low complication rate, and long-term durability.
本研究旨在评估对药物治疗无反应的有症状椎基底动脉供血不足的血管内治疗结果。
对28例在我们心脏病诊所定期随访的患者进行评估，这些患者有提示后颅窝缺血的症状，且超声评估有诊断性或可疑发现，通过选择性椎动脉和锁骨下动脉血管造影进行评估。所有患者（17例男性，11例女性；平均年龄64岁；范围54 - 87岁）在椎动脉或锁骨下动脉或两者均有严重病变（狭窄>70%）。那些被认为严重到足以解释所报告症状的病变接受了经皮介入和支架置入。所有患者通过门诊随访平均14.2个月（范围3.5 - 24.3个月）。
在接受治疗的28例患者中，置入了25个椎动脉支架和10个锁骨下动脉支架。27例患者（96%）获得成功（残余直径狭窄<20%，无卒中或死亡）。1例因左锁骨下动脉次全闭塞接受介入治疗的患者发生了后颅窝短暂性脑缺血发作。随访时，25例患者（89%）存活，其中22例（88%）无进一步的神经学主诉。3例（11%）患者在随访期间死于心脏并发症。1例（3.5%）患者在6个月时因支架内再狭窄出现复发症状，成功进行了球囊血管成形术，症状缓解。
后颅窝缺血是一种在介入心脏病学家诊治的普通患者群体中相对常见但诊断不足的疾病。使用冠状动脉导丝和支架包括药物洗脱支架的血管内治疗因其高技术成功率、低并发症率和长期耐用性，是椎动脉血运重建的首选治疗方法。
