Clinical Study On Endovascular Stenting For The Vertebral Artery Origin Stenosis

Object: To evaluate the safety and efficacy of stent implantation in the treatment of vertebral artery origin stenosis.To compare the short-term and long-term efficacy of drug-eluting stent(DES)and bare metal stent(BMS)in the treatment of vertebral artery origin stenosis.To analyze the risk factors of restenosis after stent implantation in the vertebral artery origin stenosis Methods: Retrospectively analyze of 66 patients with moderate to severe stenosis in the vertebral artery origin stenosis from August 2016 to August 2019 due to unsatisified effect of medicine therapy.Digital substraction angiography was performed to verify the vertebral artery origin stenosis.We analysed the technical effectiveness,clinical remission rate and postoperative complications.According to the type of stent implanted,these cases were divided into the group treated with metal bare stents(BMS)and the group treated with drug-eluting stents(DES).The rates of primary and secondy end point events of these two groups were compared.According to restenosis after stenting,patents were divided into the non-stenosis group and re-stenosis group.Risk factors,which might be correlated with restosis,were anlysed,including gender,age,smoking,drinking,diabetes,hypertension,hyperlipidemia,coronary heart disease,artery advantage,location of blood vessels,inner diameter of blood vessels,degree of stenosis,stenosis length,residual stenosis rate and types of stents.Results: Among the 66 patients,49 were male and 17 were female,aged 48-86 years,with an average age of(63.24±7.46)years.All patients were successfully perfomed stent placement,including 67 stents(36 bare metal stents and 31 drug-eluting stents).The techn ical success rate was 100%;5 cases(7.58%)had complications during the perioperative period.Residual and fatal stroke occurred;the clinical symptoms of most patients were relieved,and the clinical success rate was 93.94%.The NIHSS score of patients before and after surgery was not statistically significant(z =0.351,P=0.732);during follow-up,13 patients(19.70%)patients had intra-stent restenosis after operation,1(1.52%)had a bare metal stent fracture,7(10.61%)patients had TIA;3(4.55%)patients had minor strokes,1(1.52 %)was perfomed a drug-eluting stent again because of the restenosis,and no cases of major stroke,death and massive gastrointestinal bleeding occurred.The restenosis rate of patients in the BMS group was significantly higher than that in the DES group(t=5.103,P=0.039).The differences in perioperative complicationgs,Malek score,primary endpoint events and secondary endpoint events between the BMS group and the DES group were not statistically significant(P>0.05).Conclusion: The endovascular stenting for vertebral artery stenosis have a high rate of technical success,less postoperative complications and high rate of restenosis.The rate of stent restenosis was lower after eluting stents during follow-up.There was no significant difference between the two groups in TIA and recurrent stroke.Restenosis after stent placement was related to smoking,lumen diameter and types of stent.