Shao Jia-Xin, Ling Yun-Ao, Du Hua-Ping, Zhai Guo-Jie, Xu Yuan, Cao Yong-Jun
Department of Neurology, the First People Hospital of Wujiang District, 169 Gong-Yuan Road, Wujiang District, Suzhou 215200.
Department of Neurology, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, Jiangsu 215000, China.
Medicine (Baltimore). 2019 Mar;98(13):e14899. doi: 10.1097/MD.0000000000014899.
This study aimed to compare the clinical efficacy of stenting compared with standardized medical treatment in patients with moderate to severe vertebral artery origin stenosis (VAOS).Patients diagnosed with moderate to severe VAOS and indicated to undergo vertebral artery stenting were enrolled. Patients were divided into stenting group and standardized medical treatment group. All patients underwent transcranial Doppler (TCD) before and after treatment. Incidence of new cerebral infarction, transient ischemic attack (TIA), improvement of clinical symptoms, and National Institutes of Health Stroke Scale (NIHSS) score were observed.A total of 98 patients were enrolled. Vertebral artery stenting implant was accepted by 43 patients. Two weeks after treatment, the NIHSS score in the stenting group decreased significantly compared to that in the standardized medical treatment group. The modified Rankin Scale (mRS) score in the stenting group at three months was significantly lower than that in the medical treatment group (P = .044). The extent of vascular stenosis in the stent group decreased significantly (76.5 ± 10.0% vs. 13.7 ± 5.9%, t = 35.878, P = .000). The adverse events occurred in 9 (16.4%) patients in the medical treatment group and 5 (11.6%) in the stenting group (P = .506). There was one case with new cerebral infarction in the stenting group, whereas the medical treatment group showed 1 case with TIA and three with new cerebral infarction during follow-up after 3 months. The peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) of stenosis vertebral artery, and PSV of basilar artery were significantly higher in the stent group than those in the standardized medical group (P < .05).Stenting for VAOS, rather than standardized medical treatment, can effectively relieve vascular stenosis, alter vertebral-basilar artery hemodynamics, and improve neurological function, with low perioperative complications.
本研究旨在比较支架置入术与标准化药物治疗对中重度椎动脉起始部狭窄（VAOS）患者的临床疗效。纳入诊断为中重度VAOS且拟行椎动脉支架置入术的患者。将患者分为支架置入组和标准化药物治疗组。所有患者在治疗前后均接受经颅多普勒（TCD）检查。观察新发脑梗死、短暂性脑缺血发作（TIA）的发生率、临床症状改善情况及美国国立卫生研究院卒中量表（NIHSS）评分。共纳入98例患者。43例患者接受了椎动脉支架植入术。治疗两周后，支架置入组的NIHSS评分较标准化药物治疗组显著降低。支架置入组三个月时的改良Rankin量表（mRS）评分显著低于药物治疗组（P = 0.044）。支架组血管狭窄程度显著降低（76.5±10.0% vs. 13.7±5.9%，t = 35.878，P = 0.000）。药物治疗组9例（16.4%）患者发生不良事件，支架置入组5例（11.6%）患者发生不良事件（P = 0.506）。支架置入组有1例新发脑梗死病例，而药物治疗组在3个月后的随访期间有1例TIA病例和3例新发脑梗死病例。支架组狭窄椎动脉的收缩期峰值流速（PSV）、舒张末期流速（EDV）、搏动指数（PI）及基底动脉PSV均显著高于标准化药物治疗组（P < 0.05）。对于VAOS，支架置入术而非标准化药物治疗可有效缓解血管狭窄，改变椎基底动脉血流动力学，改善神经功能，且围手术期并发症发生率低。
