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背景:后循环动脉管径细、行程长、生理弯曲多、血管内支架置入治疗相当困难。目的:观察应用同轴双导管技术对后循环颅内支架置入后成功率的影响。设计、时间及地点:回顾性分析,病例来自2004-12/2008-02郧阳医学院附属人民医院神经内科。对象:选择神经内科住院患者21例,男11例,女10例,年龄50～76岁。方法:21例患者均存在后循环缺血症状,经数字减影血管造影、磁共振血管造影或CT血管造影检查确诊为后循环颅内段狭窄,狭窄程度大于70%。均行脑血管支架置入,先用单导管技术进行支架输送,输送失败后改用同轴双导管技术,单导管技术成功者为常规组,双导管技术成功者为双导管组。主要观察指标:21例患者的治疗结果及置入物的生物相容性。结果:①21例患者均首先使用单导管技术,仅有6例患者取得了成功,成功率为29%。其他15例患者采用同轴双导管技术后支架才顺利到位,并释放成功。15例释放成功的患者中1例发生V4段破裂出血,立即用鱼精蛋白中和肝素,降低血压,置入后患者轻微头痛,恢复良好,未遗留后遗症。置入成功率为93%。经χ2检验,双导管技术较常规技术支架置入成功率显著提高(P<0.05)。②除1例发生V4段血管破裂出血外,无其他不良反应发生。所有支架完全覆盖狭窄性病变,与血管壁贴合良好,无排斥反应发生,与宿主的生物相容性良好。结论:同轴双导管技术能增加支撑力,提高后循环颅内支架手术成功率,具有较高安全性及可行性。
Background: Posterior circulation arterial diameter thin, long stroke, more physiological flexion, endovascular stent placement treatment is quite difficult. OBJECTIVE: To observe the effect of coaxial dual catheter technique on success rate after posterior circulation intracranial stenting. DESIGN, TIME AND SETTING: The retrospective analysis was performed on the cases from Department of Neurology, People’s Hospital Affiliated to Yunyang Medical College from December 2004 to February 2008. PARTICIPANTS: 21 cases of inpatients with neurology were selected, including 11 males and 10 females, aged 50-76 years. Methods: Twenty-seven patients had posterior circulation ischemic symptoms. Digital subtraction angiography, magnetic resonance angiography and CT angiography were used to diagnose posterior circulation intracranial stenosis. The degree of stenosis was more than 70%. All patients underwent stenting with single-catheter technique and coaxial double-catheter technique after failure of delivery. The successful single-catheter technique was the conventional group, and the double-catheter technique was successful. MAIN OUTCOME MEASURES: The results of 21 patients and the biocompatibility of the implant. Results: ①Twenty-one patients were treated with single-catheter technique first, and only 6 patients were successful with a success rate of 29%. In the other 15 patients, the stent was successfully placed in place by coaxial double-catheter technique and released successfully. One of the 15 patients with successful dissection developed V4 rupture hemorrhage, which immediately neutralized heparin with protamine to lower blood pressure. After implantation, the patient had slight headache and recovered well without leaving sequelae. The success rate of 93%. The χ2 test showed that the success rate of bi-catheter technique was significantly higher than that of conventional technique (P <0.05). ② In addition to one case occurred V4 vascular rupture bleeding, no other adverse reactions. All scaffolds were completely covered with stenotic lesions, adhered well to the vessel wall, and had no rejection and good biocompatibility with the host. Conclusion: The coaxial double catheter technique can increase the supportive force and improve the success rate of posterior circulation intracranial stenting, which is of high safety and feasibility.