John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.
J Am Coll Cardiol. 2010 Feb 9;55(6):538-42. doi: 10.1016/j.jacc.2009.08.069.
The aim of this study was to demonstrate the safety and long-term durability of catheter-based therapy for symptomatic vertebral artery stenosis (VAS).
Symptomatic VAS carries with it a 5-year 30% to 35% risk of stroke. The 2-year mortality approaches 30% for medically managed strokes involving the posterior circulation. Surgical bypass is rarely performed, due to high morbidity and mortality. Endovascular revascularization with primary stenting offers an attractive treatment option for these patients.
One-hundred five consecutive symptomatic patients (112 arteries, 71% male) underwent stent placement for extracranial (91%) and intracranial (9%) VAS from 1995 to 2006. Fifty-seven patients (54%) had bilateral VAS, 71 patients (68%) had concomitant carotid disease, and 43 patients (41%) had a prior stroke.
Procedural and clinical success was achieved in 105 (100%) and 95 (90.5%) patients, respectively. One-year follow-up was obtained in 87 (82.9%) patients, of which 69 patients (79.3%) remained symptom-free. At 1 year, 6 patients (5.7%) had died and 5 patients (5%) had a posterior circulation stroke. Target vessel revascularization occurred in 7.4% at 1 year. At a median follow-up of 29.1 months (interquartile range 12.8 to 50.9 months), 13.1% underwent target vessel revascularization, 71.4% were alive, and 70.5% remained symptom-free.
In experienced hands, stenting for symptomatic VAS can be accomplished with a very high success rate (100%), with few periprocedural complications, and is associated with durable symptom resolution in the majority (approximately 80%) of patients. We conclude that endovascular stenting of vertebral artery atherosclerotic disease is safe and effective compared with surgical controls and should be considered first-line therapy for this disease.
本研究旨在证明基于导管的治疗方法治疗有症状椎动脉狭窄（VAS）的安全性和长期耐久性。
有症状的 VAS 存在 5 年内 30%至 35%的中风风险。对于涉及后循环的药物治疗性中风，2 年内的死亡率接近 30%。由于发病率和死亡率高，很少进行外科旁路手术。对于这些患者，原发性支架置入的血管内血运重建提供了一种有吸引力的治疗选择。
1995 年至 2006 年，105 例连续的有症状患者（112 支血管，71%为男性）接受了颅外（91%）和颅内（9%）VAS 的支架置入术。57 例患者（54%）有双侧 VAS，71 例患者（68%）有颈动脉疾病，43 例患者（41%）有既往中风。
105 例（100%）和 95 例（90.5%）患者分别达到了程序和临床成功。87 例（82.9%）患者获得了 1 年随访，其中 69 例（79.3%）仍无症状。1 年后，6 例（5.7%）患者死亡，5 例（5%）患者发生后循环中风。1 年时靶血管血运重建发生率为 7.4%。在中位数 29.1 个月（四分位距 12.8 至 50.9 个月）的随访中，13.1%进行了靶血管血运重建，71.4%患者存活，70.5%患者无症状。
在有经验的医生手中，VAS 有症状患者的支架置入术成功率非常高（100%），围手术期并发症少，大多数（约 80%）患者的症状持久缓解。我们的结论是，与手术对照组相比，血管内椎动脉粥样硬化性疾病的支架置入术是安全有效的，应被视为该疾病的一线治疗方法。
