Clinical observation of the stenting and medication for vertebral artery origin stenosis / 天津医药

Objective To compare the efficacy between stenting and medication in patients with vertebral artery origin stenosis. Methods Seventy-six patients with vertebral artery origin stenosis were divided into stent group (n=40) and medication group(n=36).The incidences of complications in the perioperative period(30 days after surgery),and the rates of cerebral ischemic events after 3 months, 6 months and 12 months were recorded in two groups. The changes of vascular stenosis after 12 months were also observed in two groups.Results Forty-three stents were implanted in 40 patients.The operation success rate was 100%,and perioperative complication rate was 12.5%.The vascular stenosis rate was decreased from(80.36±6.42)% to(18.21±5.92)% after operation in the stent group,and increased to(22.82± 9.80)% after 12 months. There was no significant difference in the vascular stenosis rate between postoperative instant and 12 months after operation (P>0.05).The vascular stenosis rate was increased from(79.98±5.76)% to(83.42±9.53)% after treatment in the medication group but no statistical significance in the difference(P>0.05).There was no significant difference in the vascular stenosis rate between the stent group and the medication group before treatment,but which was significantly lower in the stent group than that of the medication group after 12-month treatment(P<0.05).There were four cases(10%)of ischemic events in the stent group and 10 cases (27.8%) in the medication group during the follow-up period. The ischemic events were significantly lower in the stent group than those of the medication group (P<0.05). Conclusion Stenting is safe and effective for patients with vertebral artery origin stenosis,which is better than medication for preventing the occurrence of the posterior circulation ischemic events.

Spontaneous Thrombolysis of Multiple Thrombi at Distal Region of Hypoplastic Vertebral Artery After Stent-assisted Angioplasty on Vertebral Artery Origin Stenosis: Angiographic Follow-up

Vertebral artery hypoplasia (VAH) can be easily overlooked if the contralateral side vertebral artery is intact, because of compensation by the contralateral artery or cerebral collateral network. The clinical relevance and hemodynamic impact of VAH is still controversial. However, VAH has recently been considered a risk factor for posterior circulation ischemia. Ischemic stroke is seldom caused by free floating thrombi (FFT) in the artery. Pathophysiology of FFT has not yet been clarified. The state of reduced blood flow such as a vertebral artery origin stenosis may cause FFT. Their instability may make them sources of recurrent artery to artery embolism. Patients with FFT will require appropriate medical and endovascular treatment. The current case illustrates a short-term angiographic change of spontaneous thrombolysis of VAH and multiple thrombi at the distal region of the stenosed lesion after stent-assisted angioplasty for a vertebral artery origin stenosis.