Tom 12, Nr 2 (2017)
CHOROBY TĘTNIC OBWODOWYCH
Opublikowany online: 2017-05-31
Wyświetlenia strony
3503
Wyświetlenia/pobrania artykułu
38665
Wewnątrznaczyniowe leczenie objawowych zwężeń proksymalnych odcinków tętnic kręgowych
Kardiol Inwazyjna 2017;12(2):37-42.
Streszczenie
Tętnice kręgowe, powstająca z ich połączenia tętnica podstawna oraz ich gałęzie stanowią tylny krąg unaczynienia (TKU). Odpowiada on za dostarczenie krwi do pnia mózgu, tylnej części wzgórza, móżdżku, części płatów skroniowych i potylicznych. Udary niedokrwienne stanowią około 70–80% przypadków wszystkich udarów mózgu, natomiast udary z TKU stanowią około 20–30% wszystkich udarów niedokrwiennych mózgu. Objawowe zwężenie tętnicy kręgowej jest powszechnie uznaną przyczyną udaru z TKU. W populacji osób z przebytym udarem z TKU, zwężenie tętnicy kręgowej > 50% stwierdza się u 20% chorych, z czego u 9% jest to główna przyczyna udaru. Obraz kliniczny niedokrwienia kręgowo-podstawnego jest bardzo różnorodny z powodu rozległego obszaru unaczynienia. Leczeniem pierwszego rzutu jest modyfikacja czynników ryzyka oraz farmakoterapia. Chorzy, u których leczenie zachowawcze nie przynosi zadowalających efektów, są kwalifikowani do leczenia interwencyjnego — metodami chirurgicznymi lub wewnątrznaczyniowymi. Pierwszy zabieg angioplastyki balonowej tętnicy kręgowej opisano w 1981 roku; obecnie standardem są zabiegi angioplastyki z implantacją stentu, co ujęto w wytycznych European Society of Cardiology (ESC) z 2011 roku. Stenty powlekane lekiem antymitotycznym mogą zmniejszać odsetek nawrotu zwężenia w stencie implantowanym do ujścia tętnicy kręgowej w porównaniu do klasycznych stentów metalowych, choć dane z literatury nie są jednoznaczne. Duży odsetek nawrotu zwężenia w stencie w tętnicy kręgowej pozostaje problemem, niemniej w większości przypadków chorzy mogą być skutecznie leczeni zabiegiem ponownej angioplastyki.
Słowa kluczowe: objawowe zwężenie tętnic kręgowychstenty metalowestenty powlekane lekiem antymitotycznym
Referencje
- Rowland LP, Pedley TA. Merritt’s Neurology. Lippincott Williams & Wilkins. 12th Edition : 2010.
- Członkowska A, Ryglewicz D. Epidemiology of cerebral stroke in Poland. Neurol Neurochir Pol. 1999; 32: 99–103.
- Bogousslavsky J, Melle GV, Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke. 1988; 19(9): 1083–1092.
- Moulin T, Tatu L, Crépin-Leblond T, et al. The Besançon Stroke Registry: an acute stroke registry of 2,500 consecutive patients. Eur Neurol. 1997; 38(1): 10–20.
- Vemmos KN, Takis CE, Georgilis K, et al. The Athens stroke registry: results of a five-year hospital-based study. Cerebrovasc Dis. 2000; 10(2): 133–141.
- Kapral MK, Fang J, Hill MD, et al. Investigators of the Registry of the Canadian Stroke Network. Sex differences in stroke care and outcomes: results from the Registry of the Canadian Stroke Network. Stroke. 2005; 36(4): 809–814.
- Hass WK, Fields WS, North RR, et al. Joint study of extracranial arterial occlusion. II. Arteriography, techniques, sites, and complications. JAMA. 1968; 203(11): 961–968.
- Fisher CM, Gore I, Okabe N, et al. Calcification of the carotid siphon. Circulation. 1965; 32(4): 538–548.
- Labauge R, Boukobza M, Pagès M, et al. [Occlusion of the vertebral artery (100 personal cases)]. Rev Neurol (Paris). 1987; 143(6-7): 490–509.
- Pelouze GA. [Emboligenic ulcerated plaque of the foramen of the vertebral artery]. Rev Neurol (Paris). 1989; 145(6-7): 478–481.
- Mazighi M, Labreuche J, Gongora-Rivera F, et al. Autopsy prevalence of proximal extracranial atherosclerosis in patients with fatal stroke. Stroke. 2009; 40(3): 713–718.
- Caplan LR, Wityk RJ, Glass TA, et al. New England Medical Center Posterior Circulation registry. Ann Neurol. 2004; 56(3): 389–398.
- Wityk R, Chang H, Rosengart A, et al. Proximal Extracranial Vertebral Artery Disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol. 1998; 55(4): 470.
- Marquardt L, Kuker W, Chandratheva A, et al. Incidence and prognosis of > or = 50% symptomatic vertebral or basilar artery stenosis: prospective population-based study. Brain. 2009; 132(Pt 4): 982–988.
- Brott TG, Halperin JL, Abbara S, et al. American College of Cardiology Foundation/American Heart Association Task Force, American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, Society for Vascular Surgery, American Academy of Neurology, Society of Cardiovascular Computed Tomography, American College of Cardiology Foundation, American Stroke Association, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, Society for Vascular Surgery, American College of Cardiology, American Stroke Association, American Association of Neurological Surgeons, American College of Radiology, American American College of Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, Society for Vascular Surgery, American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, Society for Vascular Surgery, American Academy of Neurology and Society of Cardiovascular Computed Tomography, American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Stroke Assocation, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurolgocial Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, Society for Vascular Surgery, American Academy of Neurology and Society of Cardiovascular Computed Tomography. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. Stroke. 2011; 42(8): e464–e540.
- Edgell RC, Zaidat OO, Gupta R, et al. Multicenter study of safety in stenting for symptomatic vertebral artery origin stenosis: results from the Society of Vascular and Interventional Neurology Research Consortium. J Neuroimaging. 2013; 23(2): 170–174.
- Tendera M, Aboyans V, Bartelink ML, et al. European Stroke Organisation, ESC Committee for Practice Guidelines. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011; 32(22): 2851–2906.
- Berguer R, Flynn LM, Kline RA, et al. Surgical reconstruction of the extracranial vertebral artery: management and outcome. J Vasc Surg. 2000; 31(1 Pt 1): 9–18.
- Motarjeme A, Keifer JW, Zuska AJ. Percutaneous transluminal angioplasty of the vertebral arteries. Radiology. 1981; 139(3): 715–717.
- Cloud GC, Crawley F, Clifton A, et al. Vertebral artery origin angioplasty and primary stenting: safety and restenosis rates in a prospective series. J Neurol Neurosurg Psychiatry. 2003; 74(5): 586–590.
- Storey GS, Marks MP, Dake M, et al. Vertebral artery stenting following percutaneous transluminal angioplasty. Technical note. J Neurosurg. 1996; 84(5): 883–887.
- Ko YG, Park S, Kim JY, et al. Percutaneous interventional treatment of extracranial vertebral artery stenosis with coronary stents. Yonsei Med J. 2004; 45(4): 629–634.
- Stayman AN, Nogueira RG, Gupta R. A systematic review of stenting and angioplasty of symptomatic extracranial vertebral artery stenosis. Stroke. 2011; 42(8): 2212–2216.
- Antoniou GA, Murray D, Georgiadis GS, et al. Percutaneous transluminal angioplasty and stenting in patients with proximal vertebral artery stenosis. J Vasc Surg. 2012; 55(4): 1167–1177.
- Kizilkilic O. Vertebral artery origin stenting with buddy wire technique in tortuous subclavian artery. Eur J Radiol. 2007; 61(1): 120–123.
- Fessler RD, Wakhloo AK, Lanzino G, et al. Transradial approach for vertebral artery stenting: technical case report. Neurosurgery. 2000; 46(6): 1524–7; discussion 1527.
- Maciejewski D, Tekieli Ł, Kabłak-Ziembicka A, et al. Transradial approach for vertebral artery stenting. Postepy Kardiol Interwencyjnej. 2015; 11(1): 32–36.
- Szabo S, Abramowitz B, Vatikus P. New technique for aorto-ostial stent placement [abstract]. Am J Cardiol. 2005; 96: 212H.
- Tang F, Wang Q, Hu C, et al. Use of the Szabo technique to guide accurate stent placement at the vertebral artery ostium. J Endovasc Ther. 2013; 20(4): 554–560.
- Dumont TM, Kan P, Snyder KV, et al. Stenting of the vertebral artery origin with ostium dilation: technical note. J Neurointerv Surg. 2013; 5(5): e36.
- Rangel-Castilla L, Gandhi S, Munich SA, et al. Experience with vertebral artery origin stenting and ostium dilatation: results of treatment and clinical outcomes. J Neurointerv Surg. 2016; 8(5): 476–480.
- Hatano T, Tsukahara T, Miyakoshi A, et al. Stent placement for atherosclerotic stenosis of the vertebral artery ostium: angiographic and clinical outcomes in 117 consecutive patients. Neurosurgery. 2011; 68(1): 108–16; discussion 116.
- Lin YH, Liu YC, Tseng WYI, et al. The impact of lesion length on angiographic restenosis after vertebral artery origin stenting. Eur J Vasc Endovasc Surg. 2006; 32(4): 379–385.
- Song L, Li J, Gu Y, et al. Drug-eluting vs. bare metal stents for symptomatic vertebral artery stenosis. J Endovasc Ther. 2012; 19(2): 231–238.
- Taylor RA, Siddiq F, Memon MZ, et al. Vertebral artery ostial stent placement for atherosclerotic stenosis in 72 consecutive patients: clinical outcomes and follow-up results. Neuroradiology. 2009; 51(8): 531–539.
- Sun X, Ma N, Wang Bo, et al. The long term results of vertebral artery ostium stenting in a single center. J Neurointerv Surg. 2015; 7(12): 888–891.
- Zhou Z, Yin Q, Xu G, et al. Influence of vessel size and tortuosity on in-stent restenosis after stent implantation in the vertebral artery ostium. Cardiovasc Intervent Radiol. 2011; 34(3): 481–487.
- Piotin M, Spelle L, Martin JB, et al. Percutaneous transluminal angioplasty and stenting of the proximal vertebral artery for symptomatic stenosis. AJNR Am J Neuroradiol. 2000; 21(4): 727–731.
- Akins PT, Kerber CW, Pakbaz RS. Stenting of vertebral artery origin atherosclerosis in high-risk patients: bare or coated? A single-center consecutive case series. J Invasive Cardiol. 2008; 20(1): 14–20.
- Langwieser N, Prothmann S, Buyer D, et al. Safety and efficacy of different stent types for the endovascular therapy of extracranial vertebral artery disease. Clin Res Cardiol. 2014; 103(5): 353–362.
- Vajda Z, Miloslavski E, Güthe T, et al. Treatment of stenoses of vertebral artery origin using short drug-eluting coronary stents: improved follow-up results. AJNR Am J Neuroradiol. 2009; 30(9): 1653–1656.
- Ogilvy CS, Yang X, Natarajan SK, et al. Restenosis rates following vertebral artery origin stenting: does stent type make a difference? J Invasive Cardiol. 2010; 22(3): 119–124.
- Al-Ali F, Barrow T, Duan Li, et al. Vertebral artery ostium atherosclerotic plaque as a potential source of posterior circulation ischemic stroke: result from borgess medical center vertebral artery ostium stenting registry. Stroke. 2011; 42(9): 2544–2549.
- Langwieser N, Buyer D, Schuster T, et al. Bare metal vs. drug-eluting stents for extracranial vertebral artery disease: a meta-analysis of nonrandomized comparative studies. J Endovasc Ther. 2014; 21(5): 683–692.
- Paluszek P, Pieniążek P, Musiałek P, et al. Angioplastyka objawowych zwężeń tętnic kręgowych z zastosowaniem stentów konwencjonalnych i pokrytych lekiem antymitotycznym. Post Kardiol Interw 2009; 5. ; 1(15): 1–6.
- Tank VH, Ghosh R, Gupta V, et al. Drug eluting stents versus bare metal stents for the treatment of extracranial vertebral artery disease: a meta-analysis. J Neurointerv Surg. 2016; 8(8): 770–774.
