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目的比较Apollo支架治疗椎动脉起始部和颅内段狭窄的安全性和有效性。方法回顾性分析河南省人民医院介入科2010年1月—2011年12月使用Apollo支架治疗椎动脉单发狭窄103例患者的资料,共103处狭窄,根据狭窄部位分为椎动脉起始部组(33例)和椎动脉颅内段组(70例)。比较两组患者的临床预后、再狭窄率及并发症。结果①支架到位率为100%。术后即刻造影显示,残余狭窄率<10%的有86处,其余16处的残余狭窄率均<20%,1处因出血用弹簧圈闭塞。②有3例在围手术期出现并发症,占2.9%(3/103),其中1例并发脑出血,2例并发脑梗死,均为椎动脉颅内段组患者。椎动脉起始部组并发症的发生率(0/33)与颅内段组(3/70)比较,差异无统计学意义,P=0.549。③术后6个月影像学随访67例,其中13例发生支架内再狭窄,椎动脉起始部组再狭窄的发生率(32.1%,9/28)高于颅内段组(10.3%,4/39),差异有统计学意义,P=0.025。④术后临床随访94例,平均9个月,无死亡病例。有8例再次发生后循环脑梗死,其中椎动脉起始部组3例(3/30,10.0%),颅内段组5例(5/64,7.8%),两组比较差异无统计学意义。结论 Apollo支架治疗椎动脉狭窄是安全、有效的。椎动脉颅内段组围手术期并发症的发生率高于起始部组,而椎动脉起始部组再狭窄的发生率高于颅内段组。
Objective To compare the safety and efficacy of Apollo stent in the treatment of vertebral artery stenosis and intracranial stenosis. Methods The data of 103 patients with single stenosis of vertebral artery treated with Apollo stent in January 2010-December 2011 in Henan Province People’s Hospital were retrospectively analyzed. The data were divided into three groups according to the site of stenosis: (33 cases) and intracranial segments of vertebral artery (70 cases). The clinical prognosis, restenosis rate and complication of the two groups were compared. Results ① stent in place rate of 100%. Immediate postoperative angiography showed that there were 86 residual stenosis rates <10%, residual stenosis rates <20% for the remaining 16 sites, and 1 occlusion due to hemorrhage with coils. ② Complications occurred in 3 cases in perioperative period, accounting for 2.9% (3/103). One case had intracerebral hemorrhage and two cases complicated with cerebral infarction. All of them were patients in the intracranial segment of vertebral artery. The incidence of complications in the vertebral artery group (0/33) was not significantly different from that in the intracranial group (3/70), P = 0.549. ③ Six months after operation, 67 cases were followed up, of which 13 cases had in-stent restenosis. The incidence of restenosis in the vertebral artery group (32.1%, 9/28) was higher than that in the intracranial group (10.3% 4/39), the difference was statistically significant, P = 0.025. ④ Postoperative clinical follow-up 94 cases, an average of 9 months, no deaths. There were 8 cases of recurrent cerebral infarction, including 3 cases (3/30, 10.0%) in the beginning of vertebral artery group and 5 cases (5/64, 7.8%) in the intracranial segment group. There was no significant difference between the two groups significance. Conclusion Apollo stent treatment of vertebral artery stenosis is safe and effective. The incidence of perioperative complications in the intracranial segment of vertebral artery was higher than that in the initial segment, while the incidence of restenosis in the initial vertebral artery segment was higher than that in the intracranial segment.