椎动脉V4段狭窄的介入治疗疗效观察
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摘要
目的研究Apollo支架、Enterprise支架、Solitaire支架和Wingspan支架在治疗椎动脉狭窄中的临床效果,对比这4种支架的治疗效果和优缺点。方法回顾性队列研究分析临床确诊的椎动脉V4段狭窄患者115例,4组患者分别采用Apollo支架29例、Enterprise支架28例、Solitaire支架27例、Wingspan支架31例进行介入治疗。4组患者的一般资料差异无统计学意义。分析4组技术操作成功率、并发症、疗效和预后。结果 (1)并发症:Apollo支架置入29例,术后1例患者出现术后并发症,Enterprise支架置入28例,术后2例患者出现包括脑出血、脑梗死及死亡在内的术后并发症,Solitaire支架置入27例术后3例患者出现术后并发症,Wingspan支架置入31例术后3例患者出现并发症。4种支架在置入术后引起术后并发症之间差异无统计学意义。(2)神经功能:Apollo组患者在术后神经系统未出现极严重障碍和严重障碍。Enterprise组1例出现极严重障碍,1例患者严重障碍,2例患者中度障碍,5例患者在术后存在轻度障碍。Solitaire组1例出现极严重障碍,1例严重障碍,3例中度障碍,9例轻度障碍。Wingspan组1例极严重障碍,各有2例严重障碍以及中度障碍,7例轻度障碍。Apollo支架组术后神经系统功能恢复效果最佳,Enterprise支架效果次之,Wingspan支架效果略差于Enterprise支架,Solitaire支架效果最差。(3)残留狭窄率:Apollo支架术后血管狭窄度最低,即手术疗效最佳;Enterprise支架术后血管狭窄度略高于Apollo支架组,即术后效果次之;Wingspan支架效果略差于Enterprise支架,Solitaire支架术后血管狭窄度最高,即手术疗效最差。(4)随访结果:Apollo内支架组29例患者中未出现脑血管不良事件,1例患者椎动脉狭窄复发。Enterprise组28例中1例出现术后脑血管不良事件,2例出现了椎动脉狭窄复发。Solitaire组27例中1例出现术后脑血管不良事件,6例出现了椎动脉狭窄复发;Wingspan组31例中1例出现术后脑血管不良事件,4例出现了椎动脉狭窄复发。结论与Apollo内支架组相比,Enterprise组、Solitaire组及Wingspan组出现术后脑血管不良事件发生率及复发率显著增高,差异具有统计学意义。Apollo支架的术后疗效最佳,Enterprise支架效果次之,Wingspan支架效果略差于Enterprise支架,Solitaire支架效果最差。
Objective To study the clinical effects of Apollo stent,Enterprise stent,Solitaire stent and Wingspan stent in the treatment of vertebral artery stenosis,and to compare the therapeutic effects,advantages and disadvantages of these four stents.Methods A retrospective cohort study of 115 patients with vertebral artery stenosis in the V4 segment was performed.In the 4 groups,29 patients were treated with Apollo stent,28 Enterprise stents,27 Solitaire stents,and 31 Wingspan stents.The difference in general data between the 4 groups was not statistically significant.Analyze the success rate,complications,efficacy,and prognosis of the 4 groups of techniques.Results(1)Complications:29 cases were implanted with Apollo stents.Postoperative complications occurred in 1 patient.28 cases were implanted in Enterprise stents.Postoperatively,2 cases included cerebral hemorrhage,cerebral infarction,and death.Post-complications,Solitaire stent placement in 27 cases of postoperative complications in 3 patients,Wingspan stent implantation in 31 cases of postoperative complications.There was no statistically significant difference in the postoperative complications after implantation of the 4 stents.(2)Neurological function.There were no serious or severe disorders in the postoperative neurological system in the Apollo group.One patient in the Enterprise group had very severe disorders,one patient had severe disorders,two patients had moderate disorders,and five patients had mild disorders after surgery.One patient in the Solitaire group experienced very severe disorders,one severe disorder,three moderate disorders,and nine mild disorders.The Wingspan group had one very serious disorder,with 2 severe and moderate disorders and 7 mild disorders.The Apollo stent group had the best recovery of neurological function after operation,followed by the Enterprise stent.The Wingspan stent was slightly worse than the Enterprise stent.The Solitaire stent was the worst.(3)Residual stenosis rate:The stenosis of Apollo stent was the lowest after surgery,ie,the best surgical outcome;Enterprise Stent vascular stenosis was slightly higher than the Apollo stent group,which was the second best postoperative effect;Wingspan stent was slightly worse than Enterprise.Stent,Solitaire stents have the highest degree of vascular stenosis,which is the worst surgical outcome.(4)Follow-up results:There were no cerebral vascular adverse events in 29 patients in the Apollo stent group,and 1 patient had recurrent vertebral artery stenosis.Postoperative cerebrovascular adverse events occurred in 1 of 28 patients in the Enterprise group,and recurrent vertebral artery stenosis occurred in 2 patients.Postoperative cerebrovascular adverse events occurred in 1 of 27 patients in the Solitaire group,and recurrence of vertebral artery stenosis occurred in 6 patients.Postoperative cerebrovascular adverse events occurred in 1 of 31 patients in the Wingspan group and 4 patients had recurrent vertebral artery stenosis.Conclusion Compared with the Apollo stent group,the occurrence of postoperative cerebrovascular adverse events and the recurrence rate were significantly higher in the Enterprise group,the Solitaire group,and the Wingspan group,and the difference was statistically significant.The Apollo stent had the best postoperative results,followed by the Enterprise stent,and the Wingspan stent was slightly worse than the Enterprise stent.The Solitaire stent was the worst.
Objective To study the clinical effects of Apollo stent,Enterprise stent,Solitaire stent and Wingspan stent in the treatment of vertebral artery stenosis,and to compare the therapeutic effects,advantages and disadvantages of these four stents.Methods A retrospective cohort study of 115 patients with vertebral artery stenosis in the V4 segment was performed.In the 4 groups,29 patients were treated with Apollo stent,28 Enterprise stents,27 Solitaire stents,and 31 Wingspan stents.The difference in general data between the 4 groups was not statistically significant.Analyze the success rate,complications,efficacy,and prognosis of the 4 groups of techniques.Results(1)Complications:29 cases were implanted with Apollo stents.Postoperative complications occurred in 1 patient.28 cases were implanted in Enterprise stents.Postoperatively,2 cases included cerebral hemorrhage,cerebral infarction,and death.Post-complications,Solitaire stent placement in 27 cases of postoperative complications in 3 patients,Wingspan stent implantation in 31 cases of postoperative complications.There was no statistically significant difference in the postoperative complications after implantation of the 4 stents.(2)Neurological function.There were no serious or severe disorders in the postoperative neurological system in the Apollo group.One patient in the Enterprise group had very severe disorders,one patient had severe disorders,two patients had moderate disorders,and five patients had mild disorders after surgery.One patient in the Solitaire group experienced very severe disorders,one severe disorder,three moderate disorders,and nine mild disorders.The Wingspan group had one very serious disorder,with 2 severe and moderate disorders and 7 mild disorders.The Apollo stent group had the best recovery of neurological function after operation,followed by the Enterprise stent.The Wingspan stent was slightly worse than the Enterprise stent.The Solitaire stent was the worst.(3)Residual stenosis rate:The stenosis of Apollo stent was the lowest after surgery,ie,the best surgical outcome;Enterprise Stent vascular stenosis was slightly higher than the Apollo stent group,which was the second best postoperative effect;Wingspan stent was slightly worse than Enterprise.Stent,Solitaire stents have the highest degree of vascular stenosis,which is the worst surgical outcome.(4)Follow-up results:There were no cerebral vascular adverse events in 29 patients in the Apollo stent group,and 1 patient had recurrent vertebral artery stenosis.Postoperative cerebrovascular adverse events occurred in 1 of 28 patients in the Enterprise group,and recurrent vertebral artery stenosis occurred in 2 patients.Postoperative cerebrovascular adverse events occurred in 1 of 27 patients in the Solitaire group,and recurrence of vertebral artery stenosis occurred in 6 patients.Postoperative cerebrovascular adverse events occurred in 1 of 31 patients in the Wingspan group and 4 patients had recurrent vertebral artery stenosis.Conclusion Compared with the Apollo stent group,the occurrence of postoperative cerebrovascular adverse events and the recurrence rate were significantly higher in the Enterprise group,the Solitaire group,and the Wingspan group,and the difference was statistically significant.The Apollo stent had the best postoperative results,followed by the Enterprise stent,and the Wingspan stent was slightly worse than the Enterprise stent.The Solitaire stent was the worst.
引文
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[2] LLOYD-JONES D,ADAMS R J,BROWN T M,et al.Executive summary:heart disease and stroke statistics??2010update:a report from the American Heart Association[J].Circulation,2010,121(7):948-954.
[3] WITYK R J,LEHMAN D,KLAG M,et al.Race and sex differences in the distribution of cerebral atherosclerosis[J].Stroke,1996,27(11):1 974-1 980.
[4] RASMUSSEN P A,PERL J,BARR J D,et al.Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis:an initial experience[J].J Neurosurg,2000,92(5):771-778.
[5] SCHONEWILLE W J,WIJMAN C A,MICHEL P,et al.Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study(BASICS):aprospective registry study[J].Lancet Neurology,2009,8(8):724-730.
[6] FELDMANN E,DANEAULT N,KWAN E,et al.Chinese-white differences in the distribution of occlusive cerebrovascular disease[J].Neurology,1990,40(10):1541-1 545.
[7] VASAN R S,BEISER A,D'AGOSTINO R B,et al.Plasma homocysteine and risk for congestive heart failure in adults without prior myocardial infarction[J].JAMA,2003,289(10):1 251-1 257.
[8] VAN DEN BOSCH M A,BLOEMENKAMP D G,MALI WP,et al.Hyperhomocysteinemia and risk for peripheral arterial occlusive disease in young women[J].J Vascular Surgery,2003,38(4):772-778.
[9] HAUTH E A,GISSLER H M,DRESCHER R,et al.Angioplasty or stenting of extra-and intracranial vertebral artery stenoses[J].Cardiovasc Intervent Radiol,2004,27(1):51-57.
[10] VOETSCH B,DEWITT L D,PESSIN M S,et al.Basilar artery occlusive disease in the New England Medical Center Posterior Circulation Registry[J].Archives neurology,2004,61(4):496-504.
[11]魏秀娥,荣良群,陶中海,等.症状性椎基底动脉狭窄血管内支架成形术疗效观察[J].中国实用神经疾病杂志,2012,15(12):1-3.
[12]杨志刚,田春鸥,张磊,等.Wingspan支架治疗重度症状性颅内椎动脉粥样硬化性狭窄的疗效评价[J].中国脑血管病杂志,2013,10(7):342-364.
[13] THIJS V N,ALBERS G W.Symptomatic intracranial atherosclerosis:outcome of patients who fail antithrombotic therapy[J].Neurology,2000,55(4):490-497.
[14] HUGH S,MARKU S,SUSANNA C,et al.Rothwell,Andrew Cliftonet al.Stenting for symptomatic vertebral artery stenosis:The Vertebral Artery Ischaemia Stenting Trial[J].Neurology,2017,89(12):1 229-1 236.
[15] CHANG J Y,PARK H,KWON O,et al.Restenosis after stenting in symptomatic vertebral arterial orifice disease and considerations for better outcome[J].Interv Neuroradiol,2017,23(2):180-185.
[16]杨增烨.椎动脉狭窄与后循环缺血的相关性研究椎动脉狭窄与后循环缺血的相关性研究[J].中国实用神经疾病杂志,2015,18(11):79-80.
[17] FIELDS J D,PETERSEN B D,LUTSEP H L,et al.Drug Eluting Stents for Symptomatic Intracranial and Vertebral Artery Stenosis[J].Interv Neuroradiol,2011,17(2):241-247.
[18] HAIDER A S,GOTTLICH C,OSUMAH T,et al.Delayed Endovascular Stenting for Severe Vertebral Artery Stenosis with Precarious Thrombosis[J].Cureus,2017,9(5):1 277.
[19] TERADA T,HIGASHIDA R T,HALBACH V V,et al.Transluminal angioplasty for arteriosclerotic disease of the distal vertebral and basilar arteries[J].J Neurol Neurosurg Psychiatry,1996,60(4):377-381.
[20] CLOUDG C,CRAWLEY F,CLIFTON A,et al.Vertebral artery origin angioplasty and primary stenting:safety and restenosis rates in a prospective series[J].J Neurol Neurosurg Psychiatry,2003,74(5):586-590.
[21] EDERLE J,BONATI LH,DOBSON J,et al.Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid And Vertebral Artery Transluminal Angioplasty Study(CAVATAS):long-term follow-up of a randomised trial[J].Lancet Neurol,2009,8(10):898-907.
[22] COMPTER A,VAN DER WORP H B,SCHONEWILLE W J,et al.VAST:Vertebral Artery Stenting Trial.Protocol for a randomised safety and feasibility trial[J].Trials,2008,9:65.
[23] TARIQ N,MAUD A,SHAH Q A,et al.Clinical Outcome of Patients with Acute Posterior Circulation Stroke and Bilateral Vertebral Artery Occlusion[J].J Vasc Interv Neurol,2011,4(2):9-14.
[24] KOGURE S,SAKAI N,IIHARA K,et al.Restenosis after stent placement for ostial stenosis of vertebral artery[J].Interv Neuroradiol,2001,7(Suppl 1):167-169.
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