Alexander Matthew D, Rebhun Jeffrey M, Hetts Steven W, Amans Matthew R, Settecase Fabio, Darflinger Robert J, Dowd Christopher F, Halbach Van V, Higashida Randall T, Cooke Daniel L
Department of Radiology and Imaging Sciences, Division of Neurointerventional Radiology, Salt Lake City, Utah, USA.
Ochsner Clinical School, University of Queensland, Brisbane, Australia.
Surg Neurol Int. 2017 Nov 20;8:284. doi: 10.4103/sni.sni_255_17. eCollection 2017.
Atherosclerotic disease of the vertebrobasilar system causes significant morbidity and mortality. All lesions require aggressive medical management, but the role of endovascular interventions remains unsettled. This study examines such endovascular interventions for vertebrobasilar atherosclerosis.
Retrospective review was performed of prospectively maintained procedure logs at three hospitals with comprehensive neurointerventional services. Patients with angiographically-proven stenosis undergoing elective stent placement were selected for analysis of demographic factors, lesion characteristics, and treatment details. Multivariate analysis was performed to evaluate for associations with ischemic stroke, death, and functional status as measured by modified Rankin scale at multiple intervals.
One hundred and twenty-three lesions were treated in 110 patients. A total of 43 (58.1%) lesions caused stroke, while 66 (89.2%) caused transient ischemic attacks (TIAs). Forty lesions (32.5%) were at the vertebral origin; 97 (60.2%) were intracranial. A total of 112 (91.1%) were treated successfully. 4 (3.3%) of 10 (8.1%) procedural complications were symptomatic. Intracranial lesions were associated with death at 1 and 2 years (OR 24.91, < 0.001) and mRS >2 at last contact (OR 12.83, < 0.001). Stenting treatment with conjunctive angioplasty had lower rates of death (OR 0.303, = 0.046) and mRS >2 at last contact (OR 0.234, = 0.018) when angioplasty was performed with a device other than that packaged with the stent.
Endovascular treatment of vertebrobasilar atherosclerosis can be performed safely, particularly for vertebral origin lesions. Higher rates of technical failure and complication may be acceptable for certain intracranial lesions due to their refractory nature and the morbidity caused by such lesions. Treatment should be tailored to features of each individual lesion.
椎基底动脉系统的动脉粥样硬化疾病会导致严重的发病率和死亡率。所有病变都需要积极的药物治疗，但血管内介入治疗的作用仍不明确。本研究探讨了针对椎基底动脉粥样硬化的此类血管内介入治疗。
对三家提供全面神经介入服务的医院前瞻性维护的手术记录进行回顾性分析。选择经血管造影证实有狭窄并接受择期支架置入的患者，分析其人口统计学因素、病变特征和治疗细节。进行多变量分析，以评估在多个时间点与缺血性中风、死亡以及改良Rankin量表测量的功能状态之间的关联。
110例患者共治疗了123处病变。共有43处（58.1%）病变导致中风，而66处（89.2%）导致短暂性脑缺血发作（TIA）。40处（32.5%）位于椎动脉起始部；97处（60.2%）位于颅内。总共112处（91.1%）治疗成功。10例（8.1%）手术并发症中有4例（3.3%）出现症状。颅内病变与1年和2年时的死亡相关（比值比24.91，<0.001），且在最后一次随访时改良Rankin量表评分>2（比值比12.83，<0.001）。当使用与支架包装不同的器械进行血管成形术时，联合血管成形术的支架治疗在最后一次随访时的死亡率（比值比0.303，=0.046）和改良Rankin量表评分>2（比值比0.234，=0.018）较低。
椎基底动脉粥样硬化的血管内治疗可以安全进行，特别是对于椎动脉起始部病变。由于某些颅内病变的难治性及其所致的发病率，较高的技术失败率和并发症发生率可能是可以接受的。治疗应根据每个病变的特点进行调整。
