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目的:观察应用新型颅内支架Neuroform治疗症状性椎-基底动脉狭窄的有效性和安全性。方法:选择北华大学附属医院神经外科及宣武医院神经外科收治的37例颅内椎-基底动脉狭窄患者,经内科抗凝和抗血小板聚集治疗无效,男24例,女13例,年龄49~72岁,平均64岁。均采用微导管技术进行血管造影,行经皮血管内支架置入,接受了Neuroform颅内专用支架治疗。结果:全部例患者椎动脉狭窄和基底动脉狭窄的狭窄率从术前平均84%下降到24%,技术成功率达100%,37例患者随访时间6~22个月,平均13个月。病变动脉的狭窄程度纠正50%~90%。无血管撕裂、急性动脉闭塞、远端血管栓塞事件等并发症出现,术后1例出现完全闭塞,但无明显临床症状。3例同时置入2枚支架,其中双侧椎动脉狭窄1例,右侧椎动脉及基底动脉狭窄2例。1例患者术后3d,因未服用抗血小板聚集药物,出现支架内急性血栓形成,经给予急诊溶栓治疗后完全恢复。支架置入后电话及门诊随访临床症状均获得不同程度改善,尚未有病情加重回报。结论:Neuroform自膨式颅内专用支架的应用,有效缓解了椎-基底动脉狭窄患者缺血症状,提高了支架置入的安全性和成功率,但长期疗效需要进一步观察。
Objective: To observe the effectiveness and safety of Neuroform for the treatment of symptomatic vertebral-basilar artery stenosis using a new intracranial stent. Methods: Thirty-seven patients with intracranial vertebral-basilar artery stenosis who were admitted to Department of Neurosurgery, Affiliated Hospital of Beihua University and Department of Neurosurgery, Xuanwu Hospital were treated by internal anticoagulation and anti-platelet aggregation. There were 24 males and 13 females, 72 years old, average 64 years old. Micro catheter techniques were used for angiography, percutaneous vascular stent implantation, received a special intracranial Neuroform stent treatment. Results: The stenosis rate of vertebral artery stenosis and basilar artery stenosis decreased from 84% preoperatively to 24% in all cases. The technical success rate was 100%. The follow - up time of 37 patients was 6-22 months (average 13 months). Lesion degree of stenosis correction of 50% to 90%. No vascular tear, acute arterial occlusion, complications such as distal vascular embolization occurred, 1 case of complete occlusion, but no obvious clinical symptoms. 3 cases were implanted with 2 stents, including 1 case of bilateral vertebral artery stenosis, 2 cases of right vertebral artery and basilar artery stenosis. One patient had an acute thrombosis within 3 days after operation because of not taking anti-platelet aggregation drugs, and was completely recovered after given emergency thrombolytic therapy. The clinical symptoms of telephone and outpatient follow-up after stent placement have all been improved to varying degrees, and the disease has not yet been reported. Conclusion: The application of Neuroform self-expanding intracranial stent can effectively relieve the ischemic symptoms and improve the safety and success rate of stent implantation in patients with vertebro-basilar artery stenosis. However, long-term efficacy needs further observation.