Clinical Study On Therapy Of Angioplasty And Stenting In The Initiation Part Of Vertebral Artery Stenosis

Objective:(1)To evaluate the therapeutic effect and safety of angioplasty and stenting in the initiation part of vertebral artery stenosis.(2)To evaluate the indication,the main points of technique,the complication of periprocedual period,the prevention and care.Methods:twenty-three cases,18 males,5 females,Aging from 51 to 73 years old,mean62.56±6.10 old.stegnosis from 60%to 95%,mean(77.08±11.58)%,with vertebral artery stenosis in the initiation part were investigated. Cervical Doppler sonography,Transcranial Doppler(TCD),Computed tomography(CT)or magnetic resonance imaging(MRI),MR angiography(MRA),Digital subtraction angiography(DSA)and NIHSS were performed in all cases.With the guide of DSA,all patients were treated by means of endovascular stent under local anesthesia.6 French femoral aterry sheath was inserted after successfully Seldinger's puncture and 6 French guiding was inserted in vertebral artery near stenotic position,then insert the sacculus proprius expanding stent.After that,review the location of stent and the chang of stegnosis using DSA instantly,and NIHSS were performed at the same time.The changes of the clinical symptom between pre and post-operation,the complication of periprocedual period,the prevention and care were observed carefully.All patients were followed and evaluatied by Malek.Results:1.25 sacculus proprius expanding stents had been placed in 23 patients successfully,4 paients were underwent predilation;The degree of stenosis were improved obviously after treatment,the means stegnosis had decreased from(77.08±11.58)%to(2.40±3.57)%(P＜0.01);There was difference in the NIHSS score between preoperation and postoperation (P＜0.05);The clinical symptoms of 21 patients were disappeared or improved.The light nervousness functional disorder aggravated in 2 patients; No death and no serious nervousness functional disorder aggravated.2.23 patients were followed up for 2-18 months(means 8.7 months),TCD was performed in 18 patients,none occurred restenosis.The DSA also was reused in 3 patients,no restenosis and no shifting or collapse was happened.All patients were performed Malek,18 patients get 1 score,4 patients get 2 scores, 1 patient get 3 scores.Conclusion:1.the technique of angioplasty and stenting in the initiation part of vertebral artery stenosis is a safe and effective treatment with its high achievement ratio and low incidence rate of complication.2.Its prostecdtive efficacy and random-control study are waiting for more observation.