Departments of Neurolog, Vanderbilt University School of Medicine, Nashville, TN, USA.
Stroke. 2011 Aug;42(8):2212-6. doi: 10.1161/STROKEAHA.110.611459. Epub 2011 Jun 23.
Extracranial vertebral artery stenosis (ECVAS) is common among patients with ischemic stroke. Despite the limited knowledge of the natural history of patients with symptomatic vertebral disease, endovascular revascularization techniques are now utilized in clinical practice. We sought to determine the risk of endovascular treatment for ECVAS with a systematic review of the literature.
A search strategy was used using the terms "stenting," "vertebral," "ostium," "origin," and "extracranial" through Medline. All articles were reviewed along with their references to determine the risk and durability of endovascular treatment.
A total of 27 articles were identified that met inclusion criterion, with a total of 980 of 993 patients treated with stents. The majority of patients (56%) were noted to have contralateral vertebral artery stenosis or occlusion and 92% were symptomatic at the time of treatment. A total of 11 patients (1.1%) experienced a stroke and 8 (0.8%) experienced a transient ischemic attack within 30 days of the procedure. Drug-eluting stents were associated with lower restenosis rates (11%) compared to bare metal stents (30%) at a mean of 24 months of follow-up.
Stenting and angioplasty of ECVAS appear to have a low rate of periprocedural stroke or transient ischemic attack and restenosis rates that may not be as high as suspected. Given the frequency of ECVAS as an etiology for ischemic stroke, future studies aimed at determining efficacy of this treatment modality relative to medical therapy would be of benefit to clinicians caring for these patients.
颅外椎动脉狭窄（ECVAS）在缺血性脑卒中患者中较为常见。尽管对有症状的脊椎疾病患者的自然病史了解有限，但血管内再通技术目前已在临床实践中得到应用。我们旨在通过文献系统回顾，确定血管内治疗 ECVAS 的风险。
通过 Medline 搜索了“支架”、“脊椎”、“动脉口”、“起源”和“颅外”等术语，制定了搜索策略。对所有文章及其参考文献进行了审查，以确定血管内治疗的风险和耐久性。
共确定了 27 篇符合纳入标准的文章，共 993 例患者中有 980 例接受了支架治疗。大多数患者（56%）存在对侧椎动脉狭窄或闭塞，92%在治疗时存在症状。11 例（1.1%）患者在术后 30 天内发生卒中，8 例（0.8%）患者发生短暂性脑缺血发作。与裸金属支架（30%）相比，药物洗脱支架（11%）在平均 24 个月的随访中再狭窄率较低。
ECVAS 的支架置入和血管成形术似乎具有较低的围手术期卒中或短暂性脑缺血发作发生率，且再狭窄率可能不像预期的那么高。鉴于 ECVAS 是缺血性脑卒中的一个常见病因，未来旨在确定这种治疗方式相对于药物治疗的疗效的研究将使治疗这些患者的临床医生受益。
