Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental NeurologyАнналы клинической и экспериментальной неврологии2075-54732409-2533Eco-Vector18810.17816/psaic188Original articlesОригинальные статьиUnknownDrug-Eluting stents in the treatment of proximal vertebral artery stenosisСтенты с лекарственным покрытием в лечении стеноза проксимального сегмента позвоночных артерийhttps://orcid.org/0000-0002-8726-8928ChechetkinAndrey O.ЧечёткинАндрей Олегович
Russian Federation

D. Sci. (Med.), Head, Ultrasound diagnostic laboratory

д.м.н., зав. лаб. ультразвуковых методов исследования

andreychechetkin@gmail.comSkrylevSergey I.СкрылевСергей Иванович
Russian Federation
andreychechetkin@gmail.comKoshcheevAleksandr Yu.КощеевАлександр Юрьевич
Russian Federation
andreychechetkin@gmail.comShchipakinVladimir L.ЩипакинВладимир Львович
Russian Federation
andreychechetkin@gmail.comKrasnikovAlexey V.КрасниковАлексей Владимирович
Russian Federation
andreychechetkin@gmail.comSuslinaZ. A.СуслинаЗинаида Александровна
Russian Federation
andreychechetkin@gmail.comResearch Center of NeurologyФГБНУ «Научный центр неврологии»Research Centre of NeurologyФГБНУ «Научный центр неврологии»090620148251101022017Copyright ©; 2014, Chechetkin A.O., Skrylev S.I., Koshcheev A.Y., Shchipakin V.L., Krasnikov A.V., Suslina Z.A.Copyright ©; 2014, Chechetkin A.O., Skrylev S.I., Koshcheev A.Y., Shchipakin V.L., Krasnikov A.V., Suslina Z.A.2014Chechetkin A.O., Skrylev S.I., Koshcheev A.Y., Shchipakin V.L., Krasnikov A.V., Suslina Z.A.Chechetkin A.O., Skrylev S.I., Koshcheev A.Y., Shchipakin V.L., Krasnikov A.V., Suslina Z.A.https://creativecommons.org/licenses/by/4.0https://annaly-nevrologii.com/pathID/article/view/188

The objective of the study was to assess the efficacy of endovascular revascularization with drug-eluting stents in patients with proximal atherosclerotic stenosis of the vertebral arteries. We studied 32 subjects (61±10 years) who underwent 35 interventions of sirolimus- or tacrolimus-coated stent placement (3 patients were operated on both vertebral arteries). Twentyseven (84%) patients were symptomatic. All patients received double antiplatelet therapy after the intervention. The intervention was technically successful in 89% cases. No cases of acute stroke, myocardial infarction or death were seen in the perioperative period. Ultrasound scanning showed that stents remained completely patent. Twenty-nine (91%) subjects with 32 stents were followed-up for a mean period of 9.5 months. No acute strokes in the vertebral basin were reported, although recurrent symptoms were noted in 3 patients. In-stent restenosis was found in 16 (50%) vertebral arteries in 15 patients, and it was asymptomatic in 12 (80%) cases. Restenosis ≥50% (n=13) and re-occlusion (n=3) were seen more often in the tacrolimuseluting stents compared to the sirolimus-eluting stents (10 out of 14 cases [71%] vs. 6 out of 18 cases [33%], р=0.1794). Stent damage followed by restenosis was reported in 2 arteries (6%). Recurrent stenosis was seen more often in men (р=0.0173). To conclude, stenting of the extracranial portion of the vertebral artery is safe and clinically effective. Usage of drug-eluting stents cannot help solving the problem of reducing the high risk of restenosis in the late postoperative period.

Цель работы – оценить эффективность эндоваскулярного лечения при установке стентов с лекарственным покрытием у больных с атеросклеротическим стенозом проксимального сегмента позвоночной артерии (ПА). Тридцати двум пациентам (61±10 лет) имплантировали 35 стентов (у 3 больных с двух сторон), покрытых сиролимусом и такролимусом. Симптомы ишемии в вертебрально-базилярной системе (ВБС) имели 27 больных (84%). В послеоперационном периоде все пациенты получали двойную антиагрегационную терапию. Технический успех был достигнут в 89% случаев. В периоперационном периоде не наблюдали ни одного случая острого нарушения мозгового кровообращения (ОНМК), инфаркта миокарда или летального исхода. По данным дуплексного сканирования, стенты были полностью проходимы. В отдаленном послеоперационном периоде обследовано 29 (91%) пациентов, которым было имплантировано 32 стента. Средний срок динамического наблюдения составил 9,5 мес. ОНМК в ВБС не зафиксировано ни у одного пациента. Рецидив симптомов вертебрально-базилярной недостаточности отмечен у 3 больных. Нарушение проходимости стента выявлено в 16 (50%) ПА у 15 пациентов, которое у 12 (80%) из них имело асимптомное течение. Рестеноз ≥50% (n=13) и реокклюзия (n=3) стента чаще встречались при имплантации стентов, покрытых такролимусом, по сравнению со стентами, покрытыми сиролимусом: в 10 (71%) из 14 наблюдений против 6 (33%) из 18 случаев соответственно (р=0,1794). Повреждение целостности стента наблюдали в 2 ПАь(6%), что сопровождалось рестенозом. Частота рестенозов преобладала у лиц мужского пола (р=0,0173). Таким образом, стентирование экстракраниального отдела ПА является безопасной процедурой с хорошим клиническим эффектом. Установка стентов с лекарственным покрытием не решает проблемы снижения высокой частоты развития рестеноза в отдаленном послеоперационном периоде.

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