Effect Of Hemodynamics And Prognosis Of Stenting VS Standardized Medical Treatment In Patients With Symptomatic Moderate-severe Vertebral Artery Origin Stenosis

Objective: To discuss the clinical efficacy of stenting and standardized medical treatment in patients with symptomatic moderate-severe vertebral artery origin stenosis(VAOS).Methods: Symptomatic patients who had been diagonised with moderate-severe stenosis of vertebral artery origin by Digital Subtraction Angiography(DSA)and had indication for vertebral artery stenting were collected.Patients were divided into stenting group and standardized medical treatment group.Perioperative complications of patients in stenting group were collected.All patients accepted Transcranial Doppler(TCD)before treatment,2 weeks and 3 months after treatment.Incidence of new cerebral infarction,transient ischemic attack(TIA),improvement of clinical symptoms and NIHSS score were observed.Result:(1)A total of 98 patients were enrolled.55 patients in the standardized medical treatment group and 42 men with an average age of(64.2±7.93)years.43 patients in the stenting group and 27 men with an average age of(66.8±9.17)years.(2)There was no significant difference in NIHSS score between the two groups before treatment.2weeks,NIHSS score in stenting group decreased significantly than standardized medical treatment group.3 months after treatment,m RS score in stenting group was lower than medical treatment group(1(1,2)VS 2(1,3),P=0.044).(3)43 patients accepted vertebral artery stenting implant,meanwhile,among those patients,3 patients with subclavian artery stenosis(>70%)also accepted subclavian artery stenting.The extent of vascular stenosis in stenting group decreased significantly((76.5±10.0%)VS(13.7±5.9%),t=35.878,P<0.001).The endpoint occurred 11(20.0%)patients in medical treatment group and 10(23.3%)patients in stenting group(P=0.697).No complications such as stroke,cerebral hemorrhage,and hyperperfusion syndrome occured in all patients during the perioperative period.There was 1 patient with new cerebral infarction in stenting group,while 1 patient with TIA and 3patients with new cerebral infarction in medical treatment group.(4)Compared with standardized medical treatment group,peak systolic velocity(PSV),end diastolic velocity(EDV)and pulsatility index(PI)of stenosis vertebral artery and PSV of basilar artery were significantly higher in the stenting group(P< 0.05).Conclusion: Compared with standardized medical treatment,stenting for vertebral artery origin stenosis can effectively relieve the vascular stenosis and change vertebral-basilar artery hemodynamics,improve neurological function,with low perioperative complications,without increasing the incidence of adverse events.