Kim Jae Ho, Cho Kwang-Chun, Kim Taemin, Ha Sang Woo, Suh Sang Hyun
Department of Neurosurgery, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea.
Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.
Neurointervention. 2023 Nov;18(3):166-171. doi: 10.5469/neuroint.2023.00437. Epub 2023 Oct 19.
While symptomatic basilar artery (BA) stenosis is associated with a higher risk of recurrent stroke or death, there is no consensus on the management of these patients who are refractory to antiplatelet therapy. This study retrospectively assesses the outcomes of endovascular treatment (EVT) for symptomatic BA stenosis.
We conducted a retrospective review of patients with symptomatic BA stenosis who underwent EVT, including angioplasty or stenting, from 2006 to 2018. A total of 15 patients, who experienced transient ischemic attacks or strokes despite dual antiplatelet therapy, were included. EVT was performed under local anesthesia after pretreatment with antiplatelet medications. Angiographic follow-up was performed at 12 and 24 months post-EVT. Clinical outcomes were evaluated using the modified Rankin Scale (mRS).
EVT was successfully completed in all patients. Peri/post-procedural complications occurred in 33% of cases, including in-stent thrombosis, intracranial hemorrhage, and pontine infarction. At long-term follow-up (mean 98.5±80.5 months), 73.3% of patients achieved a favorable functional outcome (mRS≤2) without disability or mortality. Patients with unfavorable outcomes had previous infarcts, with 2 experiencing new pontine infarctions after stenting.
This study suggests that EVT, including angioplasty and stenting, may offer promise as a treatment option for symptomatic BA stenosis refractory to medical therapy. However, the procedure carries a notable risk of complications, especially in patients with severe stenosis and previous infarcts. Careful patient selection, based on clinical and radiological criteria, is crucial.
虽然症状性基底动脉（BA）狭窄与复发性中风或死亡风险较高相关，但对于这些对抗血小板治疗无效的患者的管理尚无共识。本研究回顾性评估了症状性BA狭窄的血管内治疗（EVT）的结果。
我们对2006年至2018年接受EVT（包括血管成形术或支架置入术）的症状性BA狭窄患者进行了回顾性研究。共纳入15例尽管接受了双重抗血小板治疗仍发生短暂性脑缺血发作或中风的患者。在使用抗血小板药物预处理后，于局部麻醉下进行EVT。在EVT后12个月和24个月进行血管造影随访。使用改良Rankin量表（mRS）评估临床结果。
所有患者均成功完成EVT。33%的病例发生围手术期/术后并发症，包括支架内血栓形成、颅内出血和脑桥梗死。在长期随访（平均98.5±80.5个月）中，73.3%的患者获得了良好的功能结局（mRS≤2），无残疾或死亡。结局不佳的患者既往有梗死，其中2例在支架置入后发生新的脑桥梗死。
本研究表明，包括血管成形术和支架置入术在内的EVT可能作为药物治疗无效的症状性BA狭窄的一种治疗选择。然而，该手术具有显著的并发症风险，尤其是在严重狭窄和既往有梗死的患者中。根据临床和影像学标准仔细选择患者至关重要。
