Krajíčková Dagmar, Krajina Antonín, Herzig Roman, Chovanec Vendelín, Lojík Miroslav, Raupach Jan, Renc Ondřej, Vyšata Oldřich, Šimůnek Libor
Department of Neurology, Faculty of Medicine in Hradec Králové, Charles University, 500 03 Hradec Králové, Czech Republic.
Department of Neurology, Comprehensive Stroke Center, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic.
J Clin Med. 2024 Jul 9;13(14):4010. doi: 10.3390/jcm13144010.
: In patients with vertebral artery origin (VAO) stenosis and concomitant stenoses of other cerebral feeding arteries, data on the risk of percutaneous transluminal angioplasty (PTA) alone and with stent placement (PTAS) for VAO stenosis are limited. We aimed to determine how the presence of polystenotic lesions in other cerebral feeding arteries and concomitant carotid artery stenting (CAS) affect the periprocedural risk and long-term effect of PTA/S for atherosclerotic VAO stenosis. : In a retrospective descriptive study, consecutive patients treated with PTA/S for ≥70% VAO stenosis were divided into groups with isolated VAO stenosis and multiple stenoses. We investigated the rate of periprocedural complications in the first 72 h and the risk of restenosis and ischemic stroke (IS)/transient ischemic attack (TIA) during the follow-up period. : In a set of 66 patients aged 66.1 ± 9.1 years, polystenotic lesions were present in 56 (84.8%) patients. 21 (31.8%) patients underwent endovascular treatment for stenosis of one or more other arteries in addition to VAO stenosis (15 underwent CAS). During the periprocedural period, no patient suffered from an IS or died, and, in the polystenotic group with concomitant CAS, there was one case of TIA (1.6%). During a mean follow-up period of 36 months, we identified 8 cases (16.3%) of ≥50% asymptomatic VA restenosis, and, in the polystenotic group, 4 (8.9%) cases of IS. : The presence of severe polystenotic lesions or concomitant CAS had no adverse effect on the overall low periprocedural risk of PTA/S of VAO stenosis or the risk of restenosis during the follow-up period.
对于椎动脉起始部（VAO）狭窄并伴有其他脑供血动脉狭窄的患者，关于单独经皮腔内血管成形术（PTA）以及PTA联合支架置入术（PTAS）治疗VAO狭窄风险的数据有限。我们旨在确定其他脑供血动脉多节段狭窄病变的存在以及同期颈动脉支架置入术（CAS）如何影响动脉粥样硬化性VAO狭窄的PTA/S围手术期风险和长期疗效。
在一项回顾性描述性研究中，将接受PTA/S治疗且VAO狭窄≥70%的连续患者分为单纯VAO狭窄组和多节段狭窄组。我们调查了前72小时内的围手术期并发症发生率以及随访期间再狭窄和缺血性卒中（IS）/短暂性脑缺血发作（TIA）的风险。
在一组年龄为66.1±9.1岁的66例患者中，56例（84.8%）存在多节段狭窄病变。21例（31.8%）患者除VAO狭窄外，还接受了一条或多条其他动脉狭窄的血管内治疗（15例接受了CAS）。在围手术期，无患者发生IS或死亡，在同期行CAS的多节段狭窄组中，有1例TIA（1.6%）。在平均36个月的随访期内，我们发现8例（16.3%）VA无症状再狭窄≥50%，在多节段狭窄组中，有4例（8.9%）发生IS。
严重多节段狭窄病变的存在或同期行CAS对VAO狭窄PTA/S总体较低的围手术期风险或随访期间的再狭窄风险均无不良影响。
