Department of Neurosurgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
Neurosurgery. 2011 Jan;68(1):108-16; discussion 116. doi: 10.1227/NEU.0b013e3181fc62aa.
Although it is thought to be a safe treatment option, the main concerns related to treating vertebral artery ostium (VAO) stenosis with stents have been the rate of restenosis and the uncertain long-term results.
To evaluate the angiographic and clinical results of stent placement for atherosclerotic stenosis of the VAO.
One hundred seventeen consecutive patients with atherosclerotic VAO stenosis were treated with stent placement over a period of 12 years. All patients were retrospectively analyzed through the use of a prospectively collected database. The indication criteria for this treatment protocol were symptomatic severe VAO stenoses (> 60%) and asymptomatic severe VAO stenoses (> 60%) with incidentally detected infarction in the posterior circulation. The target diameter of stent dilatation from 1997 to 2000 was the normal vessel diameter just distal to the lesion. Moderate overdilation in the proximal portion of the stents has been performed since 2001.
Successful dilatation was obtained in 116 of 117 cases. Transient neurological complications developed in 2 patients; however, no patients experienced any permanent neurological complications. One hundred four patients underwent follow-up angiography at 6 months after stenting. The restenosis rate at the 6-month follow-up was 9.6% (10 of 104). Until 2000, the restenosis rate after stenting was 13.3%. Since 2001, the restenosis rate has decreased to 4.5%. The median clinical follow-up period was 48 months. The annual rate of strokes in the posterior circulation was 0.95%.
Stent placement for atherosclerotic VAO stenosis is considered to be a feasible and safe treatment and may be effective for stroke prevention. The moderate overdilation of stents may be an effective modality for the prevention of restenosis.
尽管支架治疗被认为是一种安全的治疗选择，但与支架治疗椎动脉开口（VAO）狭窄相关的主要问题一直是再狭窄率和不确定的长期结果。
评估支架治疗椎动脉粥样硬化狭窄的血管造影和临床结果。
12 年间，117 例连续的椎动脉粥样硬化狭窄患者接受支架置入治疗。所有患者均通过使用前瞻性收集的数据库进行回顾性分析。该治疗方案的适应证标准为症状性严重 VAO 狭窄（>60%）和无症状性严重 VAO 狭窄（>60%）伴后循环意外发现梗死。1997 年至 2000 年，支架扩张的目标直径为病变远端正常血管直径。自 2001 年以来，支架近端进行了适度的过度扩张。
117 例患者中有 116 例获得了成功扩张。2 例患者出现短暂性神经并发症；然而，无患者发生任何永久性神经并发症。104 例患者在支架置入后 6 个月进行了随访血管造影。6 个月随访时的再狭窄率为 9.6%（10/104）。2000 年前，支架置入后的再狭窄率为 13.3%。自 2001 年以来，再狭窄率已降至 4.5%。中位临床随访时间为 48 个月。后循环卒中的年发生率为 0.95%。
支架治疗椎动脉粥样硬化性 VAO 狭窄被认为是一种可行且安全的治疗方法，可能对预防卒中有效。支架适度过度扩张可能是预防再狭窄的有效方法。
