Clinical Study On Endovascular Angioplasty For The Treatment Of Vertebral Artery Origin Stenosis

Object To evaluate the efficacy,safety,prevention of complications and to investigate the risk factors of restenosis after endovascular stenting,by observe the perioperative complications and efficacy of stent implantation for symptomatic stenosis of the vertebral artery origin stenosis.We can better understand the risk factors of restenosis and better treat patients in order to improve the long-term outcomes.Methods A retrospective analysis was conducted of 61 stroke patients with the vertebral artery origin stenosis in our hospital to carry out the interventional therapy from 2015 August to 2017 August.All patients were examined by cerebral digital subtraction angiography to determine the degree of vascular stenosis and intracranial perfusion.Observed patients the perioperative complications and followed up in 1,3,6,9,12,24,36 and 48 months,to evaluate the clinical efficacy according to the NIHSS score and to evaluate the stenosis degree of target vessels by ultrasonography,CTA and DSA.According to whether there was in-stent restenosis after stent implantation,the patients were divided into restenosis group and non-stenosis group.The two groups were compared in sex,age,smoking,diabetes,hypertension,coronary heart disease,vascular advantage degree,the position of the blood vessels,the vascular diameter and stenosis degree,postoperative residual stenosis and stent type factors by statistical analysis.Results 61 patients(including 49 males and 12 females)were enrolled in our study,aged44-87 years,average of(65.84±8.44)years,46 patients combined with other vascular stenosis,1 patient had severe stenosis of the bilateral vertebral arteries.All patients were completed the stent implantation successfully,and a total of 62 stents(bare stent 41 and drug-eluting stent 21)were implanted.The technical success rate was 100%.Most of the patients had improved the clinical symptoms,the clinical success rate was 98.36%,and the NIHSS score before and after operation was compared(z=-0.436,P=0.663).The stenosis rate of vertebral artery was decreased from(81.66+9.17)% to average(8.15+6.53)%(t=51.44,P=0.000).There were 3 cases of complications(4.92%)during the perioperative period,and there were no deformity stroke and death cases during the perioperative period.There were 1 cases lost to follow up.In 60 patients,the longest follow-up period was 46 months and the shortest follow-up time was January,the mean follow-up time was(12.35+9.64)months.During the follow-up period,8 patients(13.33%)suffered from transient cerebral ischemia attack,3 patients(5%)suffered from non-disabling stroke,no intervention-related serious stroke and death occurred.There were 11 cases of stent restenosis(18%),including 2 cases of stent fracture(3.23%).There were statistically significant differences in smoking(χ2=8.934,P=0.005),the diameter of internal vessels(t=-2.097,P=0.048)and the type of stent(χ2=4.505,P=0.044)between two groups.No significant differences in gender,age,blood sugar,blood pressure,blood lipid level,coronary heart disease,the degree of vascular dominance,the location of vessels,the degree of primary stenosis and postoperative residual stenosis rate between the two groups.The restenosis rate of drug-eluting stent was significantly lower than that of bare stent(t=4.505,P=0.044),which was more conducive to reduce postoperative stent restenosis.There was no significant difference in the success rate of operative technology and postoperative complications between drug-eluting stent and bare stent.Conclusion The endovascular stenting for symptomatic vertebral artery stenosis have a high rate of technical success and have less postoperative complications.Intravascular stent placement has a significant clinical effect for the treatment of the stenosis of the origin of vertebral artery.However,the rate of in-stent restenosis is high,which needs to be paid enough attention,but drug-eluting stent can reduce in-stent restenosis in postoperative patients.In conclusion,stent angioplasty is a safe and effective treatment.The short-term clinical efficacy is significant.Evidence based medical evidence for advanced treatment needs further clinical randomized controlled study.