药物洗脱支架与裸金属支架治疗有症状性椎动脉狭窄。
Drug-eluting vs. bare metal stents for symptomatic vertebral artery stenosis.
机构信息
Department of Vascular Surgery, XuanWu Hospital, and Institute of Vascular Surgery, Capital Medical University, Beijing, China.
出版信息
J Endovasc Ther. 2012 Apr;19(2):231-8. doi: 10.1583/11-3718.1.
PURPOSE
To evaluate the immediate and long-term outcomes of drug-eluting stent (DES) vs. bare metal stent (BMS) for symptomatic vertebral artery stenosis (VAS).
METHODS
From 2003 to 2010, 206 consecutive patients (158 men; mean age 66.8 years) underwent DES (sirolimus-eluting or paclitaxel-eluting) or BMS placement for symptomatic extracranial and intracranial stenoses in 219 vertebral arteries. The technical success, clinical success, periprocedural complications, target vessel revascularization (TVR), and overall survival were compared between the DES and BMS groups.
RESULTS
The technical success rate was 98.3% (119/121) for the DES group vs. 100% for the BMS group (p = 0.503). The clinical success rate was 95.5% (107/112) for the DES group vs. 97.9% (92/94) for the BMS group (p = 0.592). No periprocedural death or stroke occurred. The overall periprocedural complication rate was 2.7% (3/112) in the DES group vs. 4.3% (4/94) in BMS group (p = 0.813). The median follow-up was 43 months (range 3-95) for the DES group and 46 months (range 6-89) for BMS. At last follow-up, the TVR rate was 6.3% (7/112) for the DES group vs. 20.2% (19/94) for the BMS group (p = 0.003); 4 (3.6%) patients in the DES group and 8 (8.5%) patients in the BMS group experienced a VBS stroke (p = 0.132). By life-table analysis, the 5-year TVR rate was 4.5% (5/112) for the DES group vs. 19.1% (18/94) for the BMS group (p = 0.001). No difference was detected in the overall survival curves between the groups (p = 0.500).
CONCLUSION
Both DES and BMS are feasible, safe, and effective for symptomatic VAS. However, DES can significantly decrease the TVR rate in the long term compared with BMS.
目的
评估药物洗脱支架（DES）与裸金属支架（BMS）治疗症状性椎动脉狭窄（VAS）的即刻和长期结果。
方法
2003 年至 2010 年，206 例连续患者（158 例男性；平均年龄 66.8 岁）在 219 条椎动脉中接受 DES（西罗莫司洗脱或紫杉醇洗脱）或 BMS 治疗症状性颅外和颅内狭窄。比较 DES 和 BMS 组之间的技术成功率、临床成功率、围手术期并发症、靶血管血运重建（TVR）和总生存率。
结果
DES 组的技术成功率为 98.3%（119/121），BMS 组为 100%（p=0.503）。DES 组的临床成功率为 95.5%（107/112），BMS 组为 97.9%（92/94）（p=0.592）。DES 组围手术期无死亡或卒中发生，BMS 组围手术期总并发症发生率为 4.3%（4/94）。DES 组为 2.7%（3/112）（p=0.813）。DES 组的中位随访时间为 43 个月（范围 3-95），BMS 组为 46 个月（范围 6-89）。最后一次随访时，DES 组的 TVR 率为 6.3%（7/112），BMS 组为 20.2%（19/94）（p=0.003）；DES 组 4 例（3.6%）和 BMS 组 8 例（8.5%）患者发生 VBS 卒中（p=0.132）。通过寿命表分析，DES 组 5 年 TVR 率为 4.5%（5/112），BMS 组为 19.1%（18/94）（p=0.001）。两组之间的总生存率曲线无差异（p=0.500）。
结论
DES 和 BMS 对于症状性 VAS 都是可行的、安全的和有效的。然而，与 BMS 相比，DES 可显著降低长期 TVR 率。
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