Die Behandlung symptomatischer extrakranieller Stenosen der Arteria vertebralis mit sirolimusbeschichteten Stents: erste Erfahrungen und Ergebnisse nach 6 Monaten

Zusammenfassung

Ziel: Evaluation der klinischen und morphologischen Ergebnisse von sirolimusbeschichteten Stents bei symptomatischen extrakraniellen Stenosen der Arteria vertebralis. Methode: 8 symptomatische Stenosen der extrakraniellen Arteria vertebralis bei 7 Patienten wurden mit sirolimusbeschichteten Stents behandelt. 7 Stenosen waren im Ostium, eine weitere kranial im Segment V 1 lokalisiert. Der mittlere Stenosegrad war 85,1 % (60,9 - 98,3 %). Alle Patienten wurden klinisch und angiographisch nach 6 Monaten nachkontrolliert. Ergebnisse: Die Reststenose nach Stentimplantation betrug 20,2 % (0,0 - 38,5 %). Unmittelbar nach Stentimplantation waren die Symptome der vertebrobasilaren Insuffizienz bei allen Patienten rückgebildet oder deutlich gebessert. Nach 6 Monaten zeigten 5 der 8 Stenosen eine Intimahyperplasie mit einem Stenosegrad von > 50 %. Der durchschnittlich gemessene Stenosegrad nach 6 Monaten war 56,2 % (0,0 - 94,1 %). Klinisch waren 5 Patienten ohne Symptome einer vertebrobasilaren Insuffizienz, zwei Patienten waren wieder symptomatisch. Schlussfolgerung: Sirolimusbeschichtete Stents im extrakraniellen, ostialen Abschnitt der Arteria vertebralis haben eine hohe, unbefriedigende Restenoserate.

Abstract

Purpose: To evaluate the clinical and morphological effectiveness of sirolimus-eluting stents in patients with stenoses in the extracranial vertebral artery and to assess the 6-month results. Materials and Methods: Sirolimus-eluting stents were implanted in 8 stenoses of the extracranial vertebral artery in 7 patients with symptoms of vertebrobasilar insufficiency. Seven stenoses were located at the ostium, and one further cranially in segment V 1. The mean grade diameter of the stenoses was 85.1 % (60.9 % - 98.3 %). Clinical and angiographic follow-up was performed over a period of 6 months in all patients. Results: All lesions were successfully stented with a residual stenosis of 20.2 % (0.0 - 38.5 %). Clinically, all patients showed resolution or improvement of the symptoms after stenting. After 6 months, 5 of the 8 stenoses developed intimal hyperplasia with a stenosis grade > 50 %. The mean measured grade of stenosis after 6 months was 56.2 % (0.0 - 94.1 %). Five patients had no clinical symptoms of a vertebrobasilar insufficiency while two had recurrent symptoms. Conclusion: Sirolimus-eluting stents in the extracranial vertebral artery have a high and unsatisfactory re-stenosis rate after 6 months.

Atherosclerosis - vertebral artery - stents - drug-eluting stents - restenosis

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