Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental NeurologyАнналы клинической и экспериментальной неврологии2075-54732409-2533Eco-Vector53210.25692/ACEN.2018.3.2Original articlesОригинальные статьиUnknownСlinical and instrumental evaluation of vertebral arteries stenting efficiency in the short-term and long-term postoperative periodsКлинико-инструментальная оценка эффективности стентирования позвоночных артерий в ближайшем и отдаленном послеоперационных периодахСhechetkinAndrey O.ЧечеткинАндрей Олегович
Russian Federation
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.comTanashyanMarine M.ТанашянМаринэ Мовсесовна
Russian Federation
andreychechetkin@gmail.comMaksimovaMarina Yu.МаксимоваМарина Юрьевна
Russian Federation
andreychechetkin@gmail.comResearch Center of NeurologyФГБНУ «Научный центр неврологии»05102018123132204102018Copyright ©; 2018, Сhechetkin A.O., Skrylev S.I., Koshcheev A.Y., Shchipakin V.L., Krasnikov A.V., Tanashyan M.M., Maksimova M.Y.Copyright ©; 2018, Сhechetkin A.O., Skrylev S.I., Koshcheev A.Y., Shchipakin V.L., Krasnikov A.V., Tanashyan M.M., Maksimova M.Y.2018Сhechetkin A.O., Skrylev S.I., Koshcheev A.Y., Shchipakin V.L., Krasnikov A.V., Tanashyan M.M., Maksimova M.Y.Сhechetkin A.O., Skrylev S.I., Koshcheev A.Y., Shchipakin V.L., Krasnikov A.V., Tanashyan M.M., Maksimova M.Y.https://creativecommons.org/licenses/by/4.0https://annaly-nevrologii.com/pathID/article/view/532

Objective: to evaluate the effectiveness of transluminal angioplasty with stenting in the treatment of atherosclerotic stenosis of the vertebral arteries (VA) proximal segment.

Materials and methods. One hundred twenty-seven patients (97 men and 30 women, mean age 60 years) with symptomatic (72% of patients) and asymptomatic (28% of patients) stenosis of the VA were examined, the degree of stenosis according to X-ray angiography was 76±11%. One hundred fifteen (91%) patients with 127 (91%) implanted stents were surveyed over time (average follow-up time 13 months).

Results. Technical success was achieved in 94% of cases. In the perioperative period, no acute cerebrovascular events, myocardial infarctions or deaths were registered. Recurrence of symptoms of vertebrobasilar insufficiency was noted in 14% initially symptomatic patients. According to ultrasound study data, restenosis ≥50% or reocclusion of the VA stent was detected in 40% cases. Damage to the integrity of the stent was diagnosed in 8% cases, which in all observations was combined with restenosis. Repeated derangement of stent patency after restenting of 11 VA in the period of 4–6 months was revealed in 60% of cases (2 reocclusions and 4 restenoses).

Conclusion. Angioplasty with stenting is a safe and clinically effective method for treating atherosclerotic stenosis of the proximal segment of VA. In a cohort of 50 patients included in the study, low quality of life was observed prior to stenting of VA. Six months after the VA stenting, the quality of life of patients increasesin both physical and psychological aspects. The main problem remains to be a high incidence of restenosis or reocclusion of stents after primary and repeated endovascular intervention in the long-term postoperative period.

Цель работы – оценить эффективность транслюминальной ангиопластики со стентированием в лечении атеросклеротического стеноза проксимального сегмента позвоночных артерий (ПА).

Материалы и методы. Обследовано 127 пациентов (97 мужчин и 30 женщин; средний возраст 60 лет) с симптомным (72% пациентов) и асимптомным (28% пациентов) стенозом ПА, степень которого, по данным рентгенангиографии, составила 76±11%. В динамике (средний срок наблюдения 13 мес) обследовано 115 (91%) пациентов, которым было установлено 127 (91%) стентов.

Результаты. Технический успех был достигнут в 94% случаев. В периоперационном периоде не зафиксировано острых нарушений мозгового кровообращения, инфарктов миокарда и летальных исходов. Рецидив симптомов вертебрально-базилярной недостаточности отмечен у 14% исходно симптомных больных. По данным ультразвукового исследования, рестеноз ≥50% или реокклюзия стента в ПА выявлены в 40% случаев. Повреждение целостности стента диагностировано в 8% случаев, что во всех наблюдениях сочеталось с рестенозом. Повторное нарушение проходимости стентов после рестентирования 11 ПА в сроки 4–6 мес выявлено в 60% случаев (2 реокклюзии и 4 рестеноза).

Заключение. Ангиопластика со стентированием является безопасным и клинически эффективным методом лечения атеросклеротического стеноза проксимального сегмента ПА. В когорте 50 пациентов, включенных в исследование, до стентирования ПА наблюдались низкие показатели качества жизни. Через 6 мес после стентирования ПА показатели качества жизни пациентов повысились в физической и психологической сферах. Основной проблемой остается высокая частота рестеноза или реокклюзии стентов после первичного и повторного эндоваскулярных вмешательств в отдаленном послеоперационном периоде.

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