Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, 3010, Bern, Switzerland.
Neuroradiology. 2010 May;52(5):371-9. doi: 10.1007/s00234-010-0662-0. Epub 2010 Feb 11.
The optimal management of patients with symptomatic severe ostial vertebral artery stenosis (OVAS) is currently unclear. We analyzed the long-term outcome of consecutive patients with OVAS who received either medical treatment (MT) or vertebral artery stenting (VAS).
Thirty-nine (>70%) patients with severe OVAS were followed for a mean period of 2.8 years. The decision for VAS (n = 10) or MT (n = 29) was left to the clinician. The Kaplan-Meier method was used to assess the risk of recurrent stroke, transient ischemic attack (TIA), or death over the study period.
Patients in the VAS group were significantly younger and more likely to have bilateral VA disease (P = 0.04 and P = 0.02). VAS was successfully performed in all ten patients. The periprocedural risk within 30 days was 10% (one TIA). The overall restenosis rate was 10%. One restenosis occurred after 9 months in a patient treated with bare-metal stent. At 4 years of follow-up, VAS showed a nonsignificant trend toward a lower risk for the combined endpoint of TIA and stroke in posterior circulation compared to medical treatment (10% vs. 45%, P = 0.095; relative risk (RR) = 0.24, 95% confidence interval (CI) 0.031-1.85). Patients with bilateral VA disease had a significantly lower recurrence risk after VAS compared with medical treatment (0% vs. 91% at 4 years, P = 0.004; RR 0.10, 95% CI 0.022-0.49)
VAS was performed without permanent complications in this small series of patients with symptomatic severe OVAS. The long-term benefit seems to be confined to patients with bilateral but not to those with unilateral VA disease.
目前，对于有症状的严重椎动脉起始段狭窄（OVAS）患者，其最佳治疗方案尚不清楚。我们分析了连续接受药物治疗（MT）或椎动脉支架置入术（VAS）治疗的 OVAS 患者的长期预后。
39 例（>70%）严重 OVAS 患者平均随访 2.8 年。椎动脉支架置入术（n=10）或药物治疗（n=29）的决策由临床医生决定。采用 Kaplan-Meier 法评估研究期间复发性卒中、短暂性脑缺血发作（TIA）或死亡的风险。
VAS 组患者明显更年轻，双侧椎动脉病变的可能性更大（P=0.04 和 P=0.02）。10 例患者均成功进行了 VAS。30 天内围手术期风险为 10%（1 例 TIA）。总体再狭窄率为 10%。1 例患者在置入裸金属支架 9 个月后出现再狭窄。4 年随访时，VAS 显示在后循环 TIA 和卒中联合终点方面，风险较药物治疗有降低的趋势，但无统计学意义（10% vs. 45%，P=0.095；相对风险（RR）=0.24，95%置信区间（CI）0.031-1.85）。双侧椎动脉病变患者行 VAS 后复发风险明显低于药物治疗（4 年时分别为 0%和 91%，P=0.004；RR 0.10，95%CI 0.022-0.49）。
在本小系列有症状的严重 OVAS 患者中，VAS 无永久性并发症。长期获益似乎仅限于双侧椎动脉病变患者，而不适用于单侧椎动脉病变患者。
