椎动脉支架成形术与后循环缺血的临床研究

发布时间：2019-07-05 14:09

【摘要】：目的:初步探讨椎动脉支架成形术治疗椎动脉粥样硬化狭窄的近期、远期疗效及对缺血性脑血管病的防治意义。方法:按照入组标准收集于2013年1月至2016年12月期间在广西中医药大学附属瑞康医院住院,有症状的椎动脉动脉粥样硬化中度狭窄及以上(≥50%)的患者69例,将患者分成药物组和支架组,支架组纳入32例,药物组纳入37例,年龄在52-75岁之间。所有患者均应用CE-MRA或CTA或DSA检查,参照北美症状性颈动脉内膜切除术试验协作组(NASCET)的测量方法对血管狭窄程度进行测量评估。药物组的治疗参考《中国缺血性脑卒中和短暂性脑缺血发作二级预防指南》进行,以抗血小板聚集和调脂稳定斑块治疗作为基础治疗,同时控制脑血管病其他的可控高危因素。支架组的治疗为在药物治疗的基础上进行支架手术治疗。对所有纳入研究的患者进行随访,观察并记录两组患者的一般资料、临床症状(头晕、肢体瘫痪、平衡障碍等)的缓解情况,应用CE-MRA或CTA或DSA对患者的血管狭窄变化情况进行随访观察,并记录支架组患者植入支架前、中、后的病情变化,围手术期并发症及其处理情况。最终,支架组有2例患者,药物组有1例患者因未能按规定的方案进行治疗,而从研究中剔除。支架组30例,药物组36例患者,完成随访,平均随访期为19.3±5.6个月。结果:两组患者之间的年龄、性别、高血压、糖尿病、高脂血症、冠状动脉粥样硬化性心脏病、吸烟史、入组时椎动脉狭窄程度等基线资料之间的差异不具有统计学意义(P0.05),两组之间具有可比性。支架组30例患者成功植入椎动脉球囊扩张式支架31枚,支架植入手术成功率96.77%,支架植入前后前相比,血管狭窄程度从术前76.37±10.06%下降到7.63±4.41%,血管狭窄程度有明显的改善,术后即刻造影远端分支血管显影较前增多,支架植入术前与术后即刻血管狭窄程度对比,差异具有统计学意义(P0.05)。支架组30天内发生与手术相关的并发症2例(6.45%),1例穿刺后出现后腹膜血肿、出血性休克,1例术中出现脑血管痉挛。随访30天、6个月时两组患者的临床症状(头晕、肢体瘫痪、平衡障碍等)缓解率对比,差异具有统计学意义(P0.05);随访12个月时两组TIA发生率对比,差异具有统计学意义(P0.05);两组患者术后、12个月、24个月时血管狭窄情况对比,差异均具有统计学意义(P0.05)。随访12个月、24个月时两组临床症状缓解率对比,差异不具有统计学意义(P0.05)。随访30天、6个月、24个月时两组的TIA发生率对比,差异无统计学意义(P0.05)。两组在30天、6个月、12个月、24个月时脑梗死的发生率对比,支架组脑梗死的发生率稍少,但差异不具有统计学意义(P0.05)。结论:椎动脉支架成形术治疗症状性椎动脉起始部粥样硬化狭窄可改善患者中短期的临床症状。椎动脉支架成形术治疗椎动脉起始部粥样硬化狭窄,术后1年内有可能减少TIA的发生率。椎动脉支架成形术治疗椎动脉起始部粥样硬化狭窄与药物治疗对比,术后2年内在脑梗塞的预防上未显示出差异。椎动脉支架植入术对缺血性脑血管病的远期预防作用,尚需进一步研究。
[Abstract]:Objective: To study the short-term, long-term and long-term effect of vertebral artery stent-plasty in the treatment of atherosclerosis stenosis and the significance of the prevention and treatment of ischemic cerebrovascular disease. Methods:69 patients with moderate and moderate (50%) vertebral artery atherosclerosis with symptomatic vertebral artery atherosclerosis were collected from January 2013 to December 2016 according to the criteria for enrollment, and the patients were divided into drug group and support group. The group of stent was included in 32 cases, and the drug group was included in 37 cases, and the age was between 52 and 75 years. All patients were examined with CE-MRA or CTA or DSA, and the degree of vessel stenosis was evaluated with reference to the method of measurement of the North American symptomatic carotid endarterectomy (NSCET). The treatment of the drug group is referred to as the second-level prevention guide for ischemic stroke and transient ischemic attack in China, which is based on the treatment of anti-platelet aggregation and lipid-regulating and stable plaque treatment, and the other controllable high-risk factors of the cerebrovascular disease are also controlled. The treatment of the stent group was performed on the basis of drug therapy. All patients who were included in the study were followed up to observe and record the general information of the two groups of patients, clinical symptoms (dizziness, limb paralysis, balance disorder, etc.), and follow-up observation on the change of blood vessel stenosis by CE-MRA or CTA or DSA. The patients with the support group were recorded before, during and after the implantation of the stent, and the complications of the perioperative period and their treatment were recorded. In the end, there were 2 patients in the stent group and one patient in the drug group was excluded from the study due to the failure to perform the treatment according to the prescribed protocol. The follow-up was completed in 30 patients and 36 patients, followed by a mean follow-up period of 19.3 to 5.6 months. Results: The difference of age, sex, hypertension, diabetes, hyperlipidemia, coronary atherosclerotic heart disease and smoking history among the two groups was not statistically significant (P0.05). The success rate of stent implantation was 96.77%, and the degree of vascular stenosis was decreased from 76.37% to 10.06% to 7.63% 4.41%, and the degree of vessel stenosis was significantly improved, compared with that before and after stent implantation. There was a significant difference in the degree of vascular development in the distal branch after operation (P0.05). There were 2 cases (6.45%) of complications related to the operation within 30 days of the stent group,1 case of retroperitoneal hematoma, hemorrhagic shock and 1 case of cerebral vasospasm. The response rate of the two groups was statistically significant (P <0.05) at the follow-up of 30 and 6 months (P <0.05). The incidence of TIA in the two groups was statistically significant at the follow-up of 12 months (P0.05). The changes of blood vessel stenosis at 12 months and 24 months after operation of the two groups were statistically significant (P0.05). 12-month follow-up and 24-month follow-up, there was no significant difference between the two groups of clinical remission rates (P0.05). There was no significant difference in the incidence of TIA between the two groups at 30 days,6 months and 24 months (P0.05). The incidence of cerebral infarction in the two groups at 30 days,6 months,12 months and 24 months was less, but the incidence of cerebral infarction in the group was less, but the difference was not statistically significant (P0.05). Conclusion: Vertebral artery stent-plasty can improve the short-term clinical symptoms of the patients. Vertebral artery stent-plasty was used to treat the atherosclerotic stenosis of the vertebral artery, and it was possible to reduce the incidence of TIA within one year after the operation. Vertebral artery stenting was used to treat the stenosis of the initial part of the vertebral artery and the treatment of the drug, and no difference was shown on the prevention of cerebral infarction within 2 years after the operation. The long-term preventive effect of vertebral artery stent implantation on ischemic cerebrovascular disease requires further study.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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