Study On The Initiation Part Of Vertebral Artery Stenosis Interventional Treatment

Background:Vertebral artery stenosis is the main reason for elderly patients with posterior circulation ischemia.The prognosis of patients with symptomatic vertebral basilar artery stenosis is poor, even if the use of drugs in the treatment of active, each year as a result of stroke death and permanent disability rate up to about10%.The morbidity and mortality are high.vertebrobasilar artery stenosis artery bypass operation is not only difficult operation, trauma, and the high incidence of complications, which have been rep orted in the literature during peri-operation period.With the development of interventional techniques, with stenting angioplasty has gradually become the mainstream methods in the treatment of vertebral artery stenosis, prevent plaque off and play the role of preventing rec urrence.However, stent thrombosis, cerebral hemorrhage, existence of restenosis and hy perperfusion complications, especially the high rate of restenosis is still unavoidable problems after stenting.Therefore, to investigate the effectiveness.and safety, indications, operation methods, the prevention of complications of vertebral artery stenosis stenting,and to understand the factors of restenosis after stent implantation. Through the investigation of70cases of patients with indications for stent implantation, the patients followed up with colordoppler ultrasound (CDI), CT.angiography (CTA), digital subtraction angiography (DSA),and the symptoms of patients with restenos is by interventional therapy, to investigate the stenting treatment effectiveness and safety, the indications, operation methods, the complications and restenosis prevention method.Objective:To investigate the vertebral artery stenting treatment effectiveness and safety, and to explore the indications, operation methods, the complications and restenosis prevention method.Methods:All patients underwent preoperative color Doppler (CDI), TCD and cerebral angiography (DSA) examination. Measurement of arterial stenosis rate of carotid artery stenosis by NASCET(the north American symptomatic carotid endarterectomy trial)measurement. According to the symptoms and signs were confirmed by CT and MRI examination to exclude cerebral infarction within4weeks.DSA examination with the following indications:(1) side of vertebral artery ostial stenosis degree>70%, the other side dysplasia or completely occluded.(2) bilateral vertebral artery stenosis at the opening>50%.(3) the non dominant side of vertebralartery stenosis70%, but the side of vertebral artery and posterior inferior cerebellar artery (PICA) continued, symptoms in patients with ipsilateral P ICA insufficiencyrelated. The stenosis rate of70%-99%, the average stenosis rate was83.8%±5.7%. With the guide of DSA, all patients were treated by by means of endovascular stent under local anesthesia.6-8French femoral aterry sheath was inserted after suceessfully Seldinger’s Punetureand6-8French guiding was inserted vertebral artery near stenotic Positio, then insert the expanding stent. Afterthat, review the location of stent and the chang of stegnosis using DS A instantly, The changes of the clinical symptom between pre and post-operation We carefully observe patients, timely treatment of complications during peri operation.Clor Doppler ultrasound (CDI), CT angiography (CTA), digital subtraction angiography (DSA) follow-up after stent restenosis rate.We observed cerebrovascular disease risk factors, the length of the target lesion, residual stenosis, stent position, calcified plaque.We analyzed the correlation of the various clinical factors and restenosis.Results:80stents were implanted in70patients, preoperative stenosis rate of70%～99%, the average stenosis rate was83.8%±5.7%. The average postoperative residual stenosis rate was6.9%(0～25%). The preoperative and postoperative DSA stenosis rate is statistically significant (P<0.01); postoperative dizziness, walking instabilitysymptoms improved obviously in55cases(78.5%),2cases had mild symptoms, no severe neurological deterioration and death cases. This group of patients1patients were found to have high perfusion. The mean follow-up time was (12.5±5.4) months follow-up in70cases, CDI35cases, CTA follow-up, DSA follow-up in23cases, including14cases (20%) were found in stent restenosis (the degree of stenosis greater than50%),the symptoms of re stenosis in3cases, give again balloon angioplasty, patients symptoms improved. Conclusion:The technique of angioplasty and stenting in the initiation part of vert ebral artery stenosis is a safe and effective treatment with its high achievement ratio and low incidence rate of complication. The patients were selected strictly, careful operation to reduce the residual stenosis,after strict drug to lipid, strict control of blood sugar, These can reduce restenosis, symptomaticrestenosis is still effective treatment. Continue to expand the large sample, randomized study and long time follow-up to further the study of in stent restenosis.