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目的研究血管内支架置入治疗症状性椎动脉颅内段狭窄的长期疗效是否优于单纯药物治疗。方法选择101例椎动脉颅内段粥样硬化性重度狭窄(≥70%)患者,分为支架置入组47例和药物治疗组54例。比较2组患者围手术期并发症、再发脑血管事件、死亡及神经功能恢复等长期随访结果。结果 2组患者平均随访(23.3±19.9)个月。支架置入组发生主要终点事件6例(12.8%),药物治疗组10例(18.5%,HR=2.65,95%CI:0.84～8.33,P=0.095)。2组30 d内主要终点事件发生率比较,差异无统计学意义(P=0.247);但30 d至随访结束的累积终点事件发生率差异有统计学意义(HR=0.23,95%CI:0.07～0.81,P=0.022)。支架置入组临床预后良好的比例明显高于药物治疗组(95.7%vs 87.0%,P=0.021)。结论椎动脉颅内段成功置入支架对脑卒中预防效果优于药物治疗,其可改善患者神经功能预后。
Objective To investigate whether the long-term efficacy of endovascular stenting for treatment of intracranial stenosis of symptomatic vertebral artery is better than that of simple drug treatment. Methods A total of 101 patients with severe atherosclerotic stenosis (≥70%) in the intracranial vertebral artery were divided into two groups: 47 cases in the stent group and 54 cases in the drug group. The long-term follow-up results of perioperative complication, recurrent cerebrovascular events, death and neurological function recovery were compared between the two groups. Results The two groups were followed up for an average of (23.3 ± 19.9) months. There were 6 (12.8%) cases in the stent group and 10 in the drug group (18.5%, HR = 2.65, 95% CI: 0.84-8.33, P = 0.095). There was no significant difference in the incidence of major endpoints within 30 days in both groups (P = 0.247), but there was significant difference in the cumulative end point events between the end of follow-up and 30 days (HR = 0.23, 95% CI: 0.07 ~ 0.81, P = 0.022). The good prognosis of stent implantation group was significantly higher than that of drug treatment group (95.7% vs 87.0%, P = 0.021). Conclusion Intracranial segments of the vertebral artery were successfully treated with scaffolds in the prevention of stroke better than drug treatment, which can improve the prognosis of patients with neurological deficits.