Endovascular Treatment Of Symptomatic Vertebrobasilar Artery Stenosis And Occlusion

Objective:To investigate the feasibility,safety and effectiveness of endovascular treatment of symptomatic vertebrobasilar artery stenosis and occlusion,and to analyze the causes of perioperative major complications and stent restenosis after endovascular treatment.Material and Methods:From January 2014 to November 2016 in the study included hospital neurology department of No.1 Hospital of Jilin University of the 68 patients with posterior circulation ischemia,and was received by DSA examination revealed intracranial vertebral basilar artery system has the responsibility of more than 70%vascular stenosis or occlusion underwent endovascular treatment as the research object.Collect the basic information and high risk factors of patients at admission.Preoperative double antiplatelet treatment(aspirin 100,mg /d + clopidogrel 75 mg/d)was given at least 3-5d.Preoperative intravenous infusion of nimodipine was performed to prevent vasospasm.The stent or balloon dilatation in the treatment of patients with vascular lesions according to the target situation,postoperative low molecular weight heparin 40 mg/bid,3d;dual antiplatelet therapy(aspirin 100mg/d+ clopidogrel 75 mg/d)6 months after long-term single antiplatelet therapy.Patients were followed up by telephone or ultrasonography.Results:There were 58 cases of symptomatic vertebrobasilar artery stenosis treated bystenting,50 males and 8 females.Age is 59.14 ± 9.15 years old.Factors affecting stroke and prognosis in the enrolled patients.Among them,23 cases with diabetes,only 8 cases(34.8%),glycosylated hemoglobin < 7%.The symptoms were dizziness in 44 patients(75.9%),and only dizziness occurred in 22 cases(37.9%).Limb paralysis occurred in 17 cases(29.3%),paresthesia in 6 cases(10.3%),speech disorder in 10 cases(17.2%),visual disturbance in 9 cases(15.5%).There were 7perioperative major complications(12.8%),acute thrombosis in target vessels in 4 cases,subarachnoid hemorrhage in 1 cases,and perforating artery disease in 2 cases.Stent restenosis occurred in 8 cases(13.8%),including recurrent stroke in 3 cases,including 1 cases with severe stenosis before combined circulation.Symptomatic intracranial vertebrobasilar artery occlusion in 10 cases,8 cases were male,2 female;age 60.7 ± 6.57 years old;3 patients with previous stroke,7cases of hypertension,3 cases of diabetes,6 cases of smoking history,7 cases of preoperative LDL-C ?1.8mmol/L;6 cases of preoperative homocysteine more than15umol/L.The symptoms were dizziness in 9 cases(90%),limb paralysis in 5 cases(50%),speech disorder(20%)in 2 cases,paresthesia in 2 cases(20%),visual disturbance in 2 cases(20%).7 cases of successful opening,3 cases were not successfully opened,1 cases were treated with Apollo stent implantation,6 cases underwent balloon dilatation therapy,perioperative complications occurred in 1cases(14.29%)arterial thrombolytic therapy of acute thrombosis.3 cases of postoperative residual stenosis less than 30%,3 cases of residual 30%-50%,70% of the residual stenosis in 1 cases.The mean follow-up was 10.3 months(3-19 months),of which 4 patients had stent restenosis,and 2 had recurrent stroke,1 of whom died after locked up syndrome.Conclusion:1.Symptomatic vertebrobasilar artery stenosis,stent placement is technicallyfeasible and safe,and randomized controlled double-blind studies are needed to support it.2.Vertebrobasilar artery occlusion recanalization therapy may improve clinical prognosis,it is feasible in technology,but for the recanalization of clinical research evidence for safety and effectiveness still need a large sample of support.