Ogilvy Christopher S, Yang Xinyu, Natarajan Sabareesh K, Hauck Erik F, Sun Luona, Lewis-Mason Laura, Hopkins L Nelson, Siddiqui Adnan H, Levy Elad I
Neurovascular Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
J Invasive Cardiol. 2010 Mar;22(3):119-24.
To compare our experience with sirolimus and paclitaxel-eluting stents (drug-eluting stents [DES]) and non-drug-eluting stents (NDES) for treatment of vertebral artery (VA) origin stenosis and review the literature.
A retrospective review of our prospectively collected database was performed. Clinical and radiologic follow up was obtained by reviewing office records and radiology. Data collected included demographics, comorbidities, presenting symptoms, stenosis severity, contralateral VA stenosis and/or carotid stenosis, type of stent used, angioplasty before or after stenting, post-treatment residual stenosis, clinical and radiological follow up and retreatment. Patients with symptomatic > 60% stenosis or asymptomatic > 70% stenosis and/or a hypoplastic or occluded contralateral VA or significant carotid occlusion were chosen for revascularization.
Thirty-five patients treated with NDES and 15 treated with DES for management of VA origin stenosis were identified. The technical success rate of the procedure was 100%. There were no procedural complications. There were 7 asymptomatic patients (NDES Group-4, DES Group-3). In the NDES Group, 9 patients had pre-stent angioplasty; 2 had post-stent angioplasty. In the DES group, 4 patients had post-stent angioplasty. Symptoms resolved in 30/31 (96.8%) patients treated with NDES and 11/12 (91.7%) treated with DES. Thirty-six patients had radiologic follow up (median 21.3 months); in-stent restenosis was documented in 11 patients (NDES 9/24 [38%], DES 2/12 [17%]). Among patients receiving NDES, re-stenotic lesions required angioplasty in 7 patients. No patients in the DES group required angioplasty.
DES for treatment of VA origin stenosis may decrease the incidence of restenosis when compared to NDES. Validation in prospective, randomized, multicenter trials is necessary.
比较我们使用西罗莫司和紫杉醇洗脱支架（药物洗脱支架[DES]）及非药物洗脱支架（NDES）治疗椎动脉（VA）起始部狭窄的经验，并复习相关文献。
对我们前瞻性收集的数据库进行回顾性分析。通过查阅门诊记录和影像学资料获得临床及影像学随访结果。收集的数据包括人口统计学资料、合并症、症状表现、狭窄严重程度、对侧VA狭窄和/或颈动脉狭窄、所用支架类型、支架置入前后的血管成形术、治疗后残余狭窄、临床及影像学随访以及再次治疗情况。选择有症状且狭窄>60%或无症状且狭窄>70%以及/或者对侧VA发育不全或闭塞或严重颈动脉闭塞的患者进行血运重建。
共确定35例接受NDES治疗和15例接受DES治疗的VA起始部狭窄患者。该手术的技术成功率为100%。无手术并发症。有7例无症状患者（NDES组4例，DES组3例）。在NDES组，9例患者在支架置入前进行了血管成形术；2例在支架置入后进行了血管成形术。在DES组，4例患者在支架置入后进行了血管成形术。30/31（96.8%）接受NDES治疗的患者症状缓解，11/12（91.7%）接受DES治疗的患者症状缓解。36例患者进行了影像学随访（中位时间21.3个月）；11例患者记录有支架内再狭窄（NDES组9/24[38%]，DES组2/12[17%]）。在接受NDES治疗的患者中，7例再狭窄病变患者需要进行血管成形术。DES组无患者需要进行血管成形术。
与NDES相比，DES治疗VA起始部狭窄可能会降低再狭窄的发生率。有必要在前瞻性、随机、多中心试验中进行验证。
