摘要目的 探讨脑缺血患者在椎动脉起始部支架成形术后发生支架内再狭窄(in-stent restenosis,IRS)与该椎动脉的优势供血侧别之间的相关性及其预后.方法 收集2008年1月至2013年12月行椎动脉起始部支架成形术治疗的52例患者,留置球囊扩张支架54枚.患者术后平均随访8.5月.回顾性分析了发生IRS与病变椎动脉侧别的相关性及其预后.结果 54枚支架留置术后,多数患者症状得到缓解.行支架成形术的椎动脉中,优势供血侧(19支)、均势供血动脉(5支)及非优势供血侧(30支)支架远端正常动脉直径分别为(4.78±0.86) mm、(4.05±0.67) mm及(3.27 ±0.59)mm(P ＜0.01).13枚支架发生IRS,皆发生在非优势供血侧.非优势供血侧的IRS发生率为43％(13/30支).13处病变的术前、术后的狭窄率分别为(72.5±8.2)％、(12.3±9.7)％,随访狭窄率为(78.7±15.5)％,其中2例支架内完全闭塞.经支架内球囊扩张后,随访的狭窄率为(25.7±6.1)％.结论 椎动脉起始部支架成形术后非优势供血侧较对侧更易发生IRS.对于发生IRS患者,经球囊再次扩张后,预后较好.

abstractsObjective To investigate the correlation between the in-stent restenosis (IRS) and dominant blood supply side of this vertebral artery and its prognosis after stent angioplasty at vertebral artery origin in patients with cerebral ischemia.Methods A total of 52 patients treated with stent angioplasty at vertebral artery origin were collected from January 2008 to December 2013,and 54 balloon-expanding stents were implanted.The mean followed up time of the patients was 8.5 months after surgery.The correlation between IRS and the sides of diseased vertebral arteries and their prognosis were analyzed retrospectively.Results The symptoms were improved in most patients after implantation of 54 stents.In the vertebral arteries of performing stent angioplasty,the diameters of normal arteries of the stent distal ends of the dominant blood supply (19 branches),the balance blood supply arteries (5 branches),and non-dominant blood supply sides (30 branches) were 4.78 ± 0.86 mm,4.05 ± 0.67 mm,and 3.27 ± 0.59 mm,respectively (P ＜0.01).IRS occurred in 13 stents,and they were all on the non-dominant blood supply sides (24.1％).The incidence of IRS on the non-dominance blood supply sides was 43％ (13/30 branches).The preoperative and postoperative stenosis rates were 72.5 ± 8.2％ and 12.3 ± 9.7％ respectively in 13 lesions,the follow-up stenosis rate was 78.7 ± 15.5％,and 2 of them had complete instent occlusion.After in-stent balloon dilatation,the follow-up stenosis rate was 25.7 ± 6.1％.Conclusion The non-dominance blood supply side is more prone to IRS after stent angioplasty at vertebral artery origin.The prognosis is better for patients with IRS after balloon re-dilatation.