Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Lixia District, Jinan, China; Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Lixia District, Jinan, China.
Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Lixia District, Jinan, China; Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Lixia District, Jinan, China.
World Neurosurg. 2020 Mar;135:316-323. doi: 10.1016/j.wneu.2019.12.132. Epub 2019 Dec 30.
Endovascular recanalization of symptomatic vertebral ostial occlusion in the nonacute phase has not been well documented. Distal thromboembolic events negatively affect the success of endovascular treatment. We aimed to investigate the feasibility, safety, and outcomes of stenting performed with the use of a distal embolic protection device for patients with symptomatic vertebral ostial occlusion in the nonacute phase.
We retrospectively reviewed the data of 7 patients with symptomatic vertebral ostial occlusion despite medical management who underwent stenting performed using a distal embolic protection device between January 2015 and February 2019. The occlusive lesions were predilated with small balloons, followed by placement of distal embolic protection devices and stents sequentially. At last, the protection devices were retrieved. The rate of successful recanalization, perioperative complications, and clinical and angiographic outcomes were analyzed.
The rate of successful recanalization was 100% with all distal embolic protection devices deployed and retrieved. Poststenting angiography showed no significant residual stenosis. There were no major acute thromboembolic events during and after the procedure. There were no recurrent ischemic symptoms after a mean clinical follow-up of 20.6 ± 16.3 months. At 6-month imaging follow-up, repeat vascular images from 5 patients showed asymptomatic restenosis in 1 artery.
Our single-center preliminary experience indicated that performing stent placement for vertebral ostial occlusion using a distal protection device may be feasible with a high rate of procedural success. However, this strategy should be confirmed in future prospective randomized studies with larger patient numbers.
非急性期有症状的椎动脉开口闭塞的血管内再通尚未得到充分证实。远段血栓栓塞事件会对血管内治疗的成功产生负面影响。我们旨在研究使用远端保护装置对非急性期有症状的椎动脉开口闭塞患者进行支架置入的可行性、安全性和结果。
我们回顾性分析了 2015 年 1 月至 2019 年 2 月期间 7 例经药物治疗后仍有症状的椎动脉开口闭塞患者的资料，这些患者接受了使用远端保护装置的支架置入术。闭塞病变先用小球囊预扩张，然后依次放置远端保护装置和支架。最后，取出保护装置。分析了再通率、围手术期并发症、临床和血管造影结果。
所有远端保护装置均成功放置和取出，再通率为 100%。支架置入后血管造影显示无明显残余狭窄。术中及术后无重大急性血栓栓塞事件。平均临床随访 20.6±16.3 个月后无复发性缺血症状。5 例患者在 6 个月影像学随访时，1 例患者 1 条动脉出现无症状再狭窄。
我们的单中心初步经验表明，使用远端保护装置进行椎动脉开口闭塞支架置入可能具有较高的手术成功率，但这一策略应在未来更大样本量的前瞻性随机研究中得到证实。
