The Comparative Analysis Of Efficacy With Basilar Artery Stenosis Stent Therapy And Drug Treatment

Object：Through the symptomatic basilar artery stenosis stentingafter a year and patients suitable for stent therapy with oral drug therapyon the comparative study, To study the restenosis rate,re-occlusion rate,incidence of new ischemic cerebrovascular events and NIHSS score withbasilar artery stenosis stent therapy and drug treatment before and after ayear, and make comparison and analysis. Confirmed that the efficacy andsafety of treatment of basilar artery stenosis stenting.Methods: In July2011to March2012CangZhou central hospital,Department of Neurology, patients hospitalized for ischemiccerebrovascular disease data, selected by the head and neck CTA (CTangiography) and DSA (cerebral angiogram) confirmed the presence ofsymptomatic basilar artery stenosis in76patients, including40patientsunderwent medical therapy,36patients underwent stenting. The selectedcases are symptomatic basilar artery stenosis, stenosis≥50%,Excludinghas associated with intracranial tumors, intracranial arteriovenousmalformations, severe cardiopulmonary liver and kidney disease, severebleeding tendency, there are contraindications malignant tumor survivalof less than2years and signed by the patients and their familiesconsent.The drug-treated patients in accordance with the strokeprevention guidelines for the formal effective treatment.Stent treatmentgroup of patients were given aspirin300mg, Clopidogrel75mg or Plavix75mg with preoperative3~5day,each once-daily oral, Routinepreoperative conducted blood tests and blood coagulation routine, liver,renal function, six items of hepatitis B, antibody of syphilis, HIVantibody test, ECG, CT/MRI, head CTA or DSA examination, andNIHSS score. Preoperative skin preparation, fast water,2hours prior tosurgery and intraoperative, postoperative continuous pump point of Nimodipine Injection detection and control of blood pressure, preventarterial spasm,Low molecular weight heparin was given3days afteroperation, the treatment of heparin sodium into the pot of treatment toprevent stent thrombosis, Given aspirin300mg within6months after theoperation, clopidogrel75mg, atorvastatin calcium20mg oral, each1timesa day, Given after6months postoperatively Aspirin100mg once a dayuntil the lifelongAfter1,3,6months TCD (TCD), neck vascular ultrasound,12months after head and neck CTA or DSA, head CT or MRI examinationrecorded intraoperative, perioperative complications, the number ofischemic cerebrovascular disease, stent restenosis, occlusion, NIHSSscore changes to comprehensive assessment. The statistical method usingthe measuring data to mean±standard deviation, sample rate between thetwo groups were compared with x2test, P<0.05considered statisticallysignificant.Result：140patients with symptomatic basilar artery stenosis drug treatmentgroup and36cases of symptomatic basilar artery stenosis sten in patientswith the admission of the two groups of patients, average age, gender,underlying diseases, such as hypertension, diabetes, hyperlipidemia,etc.history is similar between the two groups showed no significantdifference, comparable.2Stent in the treatment of patients in1cases (2.7%) had hemiplegia,and reviewed the CT visible pontine lacunar infarction, symptomsimproved given antiplatelet and Improving blood circulation aftertreatment, in1cases (2.7%) had a small amount of pontine hemorrhage,discontinuation of antiplatelet therapy given and anticoagulation therapy,reducing intracranial pressure with dehydration7days after treatment andreviewed the CT absorption of hemorrhage336cases of patients with basilar artery stenosis stenting operationare all successful, stent group support the preoperative average stenosis (66.22±11.80)%, postoperative residual stenosis rate was (12.78±9.52)%, the average NIHSS score was1.69±2.01; drug therapy groupbasilar artery stenosis rate was (60.63±12.97)%, the average NIHSSscore was2.03±2.55.12months after the stent in the treatment grouphad4cases≥50%stenosis (11.1%), including1cases of patients weresymptomatic restenosis (2.7%), the pontine infarction, cerebral vasculardisease (cerebral infarction) in1cases (2.7%),0cases of basilar arteryocclusion, stenosis rate (18.75±16.71)%, the mean NIHSS score was1.03±1.48,. The drug therapy group patients with basilar artery stenosiswas about (80.75±47.43)%, occlusion in2cases (5%), and ischemiccerebral vascular disease in7cases (17.5%) among2patients withtransient ischemic, cerebral infarction in5cases, including1cases oflocked-in syndrome serious disability, the mean NIHSS score was2.45±2.76. Two groups of patients with stenosis, occlusion, cerebral infarctionin probability, there were significant differences in NIHSS score P<0.05.Conclusion:1Stent therapy group of36basal artery carotid stenting, routineintraoperative, perioperative has few complications, no obvious sequelaeafter treatment, the relative safety..2Stent group in the12months after the rate of vascular stenosis,occlusion rate of new ischemic cerebrovascular disease, average NIHSSscore all aspects is obviously better than the drug treatment group afterstatistics processing3Strictly controlled indications for stent, the operation skills,appropriate scaffold materials, standardized perioperative treatment is thekey to reduce the risk of stent.Finally to sum up, stent in the treatment of direct expansion stenosedvessels, improve blood flow, improve cerebral blood supply, and improvebrain function, reduce the patient’s mortality, drug treatment can not bereplaced, but stenting, perioperative still complications appear, there isstill the postoperative stent restenosis vascular risk factors need active treatment, regular medication, reduce complications and the prevention ofrestenosis, but the sample size is small, need a large sample studyandobservation.