Department of Vascular Surgery, First Hospital of Tsinghua University, Beijing, China.
J Endovasc Ther. 2013 Aug;20(4):554-60. doi: 10.1583/13-4298.1.
To evaluate the Szabo technique in stenting at the vertebral artery ostium.
Between 2010 and 2011, 26 patients (21 men; mean age 67 years) with symptomatic vertebral artery ostial stenosis >60% were treated. Under distal filter protection, a 0.014-inch guidewire was introduced in the ipsilateral subclavian artery as the marker wire for the Szabo technique. The balloon-expandable paclitaxel-embedded Yinyi stent was mounted on the filter's guidewire in a monorail configuration. One strut segment only of the last stent cell was gently flared by forceps, and the outer end of the marker wire was introduced through the flared strut of the stent. The lifted strut was then crimped back into place. Holding the two wires together, the stent/balloon system was gently advanced into the ostial lesion until the marker wire stopped advancing and resistance was appreciated. The stent was deployed at 6 atmospheres, after which the balloon was deflated to 2 to 4 atmospheres, the marker wire was withdrawn, and the stent was postdilated at a high pressure (10-12 atmospheres) after withdrawing the balloon one half to one third outside of the stent to ensure that the protruding strut was flush against the wall of the subclavian artery.
The technical success rate was 100% with accurate stent deployment. The mean degree of stenosis reduced from 84.5%±6.1% to 6.2%±3.1%. Symptoms were resolved in 20 cases and were improved in 6 cases with prior stroke. No obvious in-stent restenosis was revealed by imaging at 12.0±2.2 months. No procedure-related stroke or transient ischemic attacks occurred at a follow-up for 24.0±3.7 months.
The Szabo technique is safe and effective in guiding accurate placement of the Yinyi stent at the vertebral artery ostium, which may help lower restenosis rates.
评估 Szabo 技术在椎动脉开口支架置入中的应用。
2010 年至 2011 年，对 26 例（21 例男性；平均年龄 67 岁）症状性椎动脉开口狭窄>60%的患者进行了治疗。在远端滤网保护下，将 0.014 英寸导丝引入同侧锁骨下动脉作为 Szabo 技术的标记导丝。将紫杉醇包被的 Yinyi 球囊扩张支架安装在滤网导丝上，形成单轨结构。用止血钳轻轻扩张最后一个支架单元的一个支柱节段，将标记导丝的外端穿过扩张的支架支柱。然后将抬起的支柱重新压回原位。将两根导丝一起握住，将支架/球囊系统轻轻推进到动脉口病变处，直到标记导丝停止前进并感觉到阻力。支架在 6 个大气压下扩张，然后将球囊放气至 2 至 4 个大气压，撤回标记导丝，在撤回球囊一半至三分之一至支架外后，以高压力（10-12 个大气压）对支架进行后扩张，以确保突出的支柱与锁骨下动脉壁齐平。
技术成功率为 100%，支架定位准确。狭窄程度从 84.5%±6.1%降至 6.2%±3.1%。20 例症状缓解，6 例有先前中风的症状改善。12.0±2.2 个月影像学检查未见明显支架内再狭窄。24.0±3.7 个月随访无与操作相关的卒中或短暂性脑缺血发作。
Szabo 技术在引导椎动脉开口处 Yinyi 支架准确放置方面是安全有效的，这可能有助于降低再狭窄率。
