Tian Chunou, Liu Bin, Liu Jianmin, Hong Bo, Zhao Puyuan, Yang Liangliang, Li Qiuping, Yang Zhigang
Department of Neurosurgery, The First Naval Hospital of Southern Theater Command of PLA Zhanjiang, Guangdong, China.
Department of Neurology, Shanghai Minhang Central Hospital Shanghai, China.
Am J Transl Res. 2021 Mar 15;13(3):1607-1616. eCollection 2021.
To compare the safety and efficacy of self-expandable stents (SES) and balloon-mounted stents (BMS) in the treatment of severe symptomatic intracranial vertebral artery atherosclerotic stenosis (SIVAAS).
The clinical and imaging data of 76 consecutive cases who were stented for SIVAAS in our centers in ten years were reviewed retrospectively. The cases were divided into SES group and BMS group as per the type of stents. Conventional risk factors of atherosclerosis, the relationship between stenosis and the origin of posterior inferior cerebellar artery (PICA), whether the stenosis was located at the dural-entry zone of the vertebral artery (VA), the interventional access, periprocedural complications, and clinical and imaging follow-up results were analyzed statistically.
77 stenotic lesions in 76 cases were included. Totally 51 SES and 26 BMS were implanted successfully. There was no significant difference in periprocedural complications (1 vs. 2, P = 0.544), incidence of restenosis (13.2% vs. 14.3%, P = 0.628) and long-term death or stroke (4 vs. 7, P = 0.33) between the two groups. The degree of residual stenosis in SES group was higher than in BMS group (10 (0%-40%) vs. 0 (0%-15%); P = 0). More BMS were selected in lesions located at the dural-entry zone of VA (45.1% vs. 73.1%, P = 0.02). There were more BMS implanted when lesions located proximal to origin of PICA (SES vs. BMS = 23.5% vs. 57.7%, P = 0.003) or when lesions with straighter access (SES vs. BMS = 29.4% vs. 69.2%, P = 0.001). More SES implanted when lesions located distal to PICA (SES vs. BMS = 43.1% vs. 15.4%, P = 0.015) or when lesions with moderate tortuous access (SES vs. BMS = 60.8% vs. 23.1%, P = 0.002). For stenotic lesions with moderate tortuous interventional access, SES group cases had longer survival time without stroke or death (P = 0.008).
Both SES and BMS showed high safety and efficacy for the treatment of SIVAAS. SES was more recommended for the stenotic lesions with tortuous interventional access. BMS was more recommended for the lesions located at the dural-entry zone of VA or proximal to PICA origin.
比较自膨式支架（SES）和球囊扩张式支架（BMS）治疗症状性重度颅内椎动脉粥样硬化狭窄（SIVAAS）的安全性和有效性。
回顾性分析我们中心10年间连续76例因SIVAAS接受支架置入术患者的临床和影像资料。根据支架类型将病例分为SES组和BMS组。对动脉粥样硬化的传统危险因素、狭窄与小脑后下动脉（PICA）起源的关系、狭窄是否位于椎动脉（VA）硬膜入口区、介入通路、围手术期并发症以及临床和影像随访结果进行统计学分析。
76例患者共纳入77处狭窄病变。成功植入SES 51枚，BMS 26枚。两组围手术期并发症（1例 vs. 2例，P = 0.544）、再狭窄发生率（13.2% vs. 14.3%，P = 0.628）以及长期死亡或卒中发生率（4例 vs. 7例，P = 0.33）差异均无统计学意义。SES组残余狭窄程度高于BMS组（10（0%-40%） vs. 0（0%-15%）；P = 0）。VA硬膜入口区病变更多选用BMS（45.1% vs. 73.1%，P = 0.02）。PICA起源近端病变（SES组 vs. BMS组 = 23.5% vs. 57.7%，P = 0.003）或介入通路较直的病变（SES组 vs. BMS组 = 29.4% vs. 69.2%，P = 0.001）更多植入BMS。PICA远端病变（SES组 vs. BMS组 = 43.1% vs. 15.4%，P = 0.015）或介入通路中度迂曲的病变（SES组 vs. BMS组 = 60.8% vs. 23.1%，P = 0.002）更多植入SES。对于介入通路中度迂曲的狭窄病变，SES组患者无卒中或死亡的生存时间更长（P = 0.008）。
SES和BMS治疗SIVAAS均显示出较高的安全性和有效性。对于介入通路迂曲的狭窄病变，更推荐使用SES。对于位于VA硬膜入口区或PICA起源近端的病变，更推荐使用BMS。
