Zusammenfassung
Ziel: Vorgestellt werden die klinischen und duplexsonografischen Langzeitergebnisse von Hochrisiko-Patienten mit hochgradigen, rezidivierend symptomatischen intrakraniellen Stenosen der vertebrobasilären Achse. Unsere Hypothese ist, dass dieses Kollektiv ein hohes periprozedurales Risiko trägt und trotzdem von der Behandlung im Vergleich mit dem zu erwartenden Spontanrisiko profitiert. Wir vermuteten außerdem, dass die Langzeitergebnisse vom initialen Behandlungsergebnis und der Verwendung von Stents abhängen. Material und Methoden: In einer Analyse unserer prospektiven Datenbank zwischen 1997 und 2006 wurden 72 Patienten identifiziert, von denen 42 Patienten an 45 Stenosen des hinteren Kreislaufs endovaskulär behandelt wurden. Alle Patienten wurden von unabhängigen, in der vaskulären Diagnostik erfahrenen Neurologen klinisch und dopplersonografisch periinterventionell und im Verlauf untersucht. Ergebnisse: Die technische Erfolgsrate lag bei 93 %. In 67 % wurden Stents verwendet. Eine initiale postprozedurale klinische Verschlechterung fand sich nach 30 Tagen bei 24 % der Patienten. 17,8 % der Patienten waren nach durchschnittlich 26,3 Monaten klinisch verschlechtert. 11,1 % der Patienten waren durch die Intervention dauerhaft schwer geschädigt (mRS 3 – 6). 9,5 % der Patienten hatten Restenosen. Ein neuer Schlaganfall konnte im Verlauf der Nachuntersuchung nicht nachgewiesen werden. Schlussfolgerung: Die endovaskuläre Behandlung von Hochrisiko-Patienten mit rezidivierend symptomatischen intrakraniellen Stenosen der vertebrobasilären Achse reduziert deren Schlaganfall- und Mortalitätsrisiko im Verhältnis des zu erwartenden Spontanverlaufs. Die Verwendung von Stents hatte keinen signifikanten Einfluss auf das klinische Langzeitergebnis.
Abstract
Purpose: We present long-term clinical and duplex data from high-risk patients with severe, recurrent symptomatic stenoses of the vertebrobasilar circulation. We hypothesized that despite the greater risk of periprocedural complications in this patient group, interventional treatment would reduce the risk of recurrent strokes relative to the expected natural risk. We also predicted that the long-term treatment outcome would be positively influenced by the use of stents and by the periprocedural technical success rate. Materials and Methods: An analysis of our patient data base yielded 45 cases of stenosis of the vertebrobasilar circulation treated endovascularly in 42 patients between 1998 and 2006. Clinical and vascular diagnostic tests, both periinterventionally and during follow-up, were performed independently by experienced neurologists. Results: The technical success rate was 93 %. Stents were used in 67 % of the procedures. After 30 days, 24 % of the patients showed post-procedural clinical deterioration. After an average period of 26.3 months, 17.8 % of the patients had deteriorated. 11.1 % of the patients suffered severe permanent damage as a result of the procedure (mRs 3 – 6). Restenosis was found in 9.5 % of the cases. There were no instances of a recurrent stroke during follow-up. Conclusion: For this population of high-risk patients with recurrently symptomatic intracranial stenoses of the vertebrobasilar axis, endovascular treatment reduced the risk of stroke and death relative to the expected natural risk. The use of stents had no significant effect on the long-term results.
Key words
CNS - angioplasty - cerebral angiography - stroke - intracranial stenoses
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Dr. Oliver Wittkugel
Neuroradiologie, Universitätsklinikum Hamburg-Eppendorf
Martinistraße 52
20246 Hamburg
Phone: ++ 49/40/4 28 03 27 46
Fax: ++ 49/40/4 28 03 46 40
Email: wittkugelo@web.de