血管支架成形术在颅内椎-基底动脉狭窄中的临床应用

目的探讨经皮血管支架成形术治疗椎动脉颅内段和基底动脉狭窄。方法对24例椎动脉颅内段和基底动脉狭窄患者进行血管造影，行经皮血管内支架置入术，并根据患者血管狭窄程度给予预扩张或后扩张。结果24例患者椎动脉狭窄和基底动脉狭窄的狭窄率从术前平均84％下降到24％，术后均没有缺血性卒中发作。随访13个月，22例患者临床症状消失，2例患者遗有永久性神经功能障碍，其中1例与手术有关，1例与颅内血管远端病变有关。结论椎动脉颅内段和基底动脉狭窄患者，内科治疗无效时，经皮血管内支架置人术可以缓解椎-基底动脉狭窄患者缺血症状，预防卒中再发生。     

血管内支架置入术治疗椎-基底动脉延长扩张症

目的探索使用血管内支架技术治疗椎-基底动脉延长扩张症（VBD）的可行性、有效性和安全性。方法回顾性分析2004年1月-2010年1月,上海第二军医大学长海医院神经外科采用血管内支架置入术治疗的5例VBD患者。结果①5例患者中,VBD合并椎-基底动脉急性夹层1例,VBD合并椎动脉动脉瘤1例,VBD引起三叉神经痛l例,VBD致后循环缺血、梗死2例。②每例VBD患者平均置入3（1～5）枚LEO支架和3．8（0～8）枚弹簧圈,重建椎-基底动脉的血流。③所有患者血管重建成功,术后症状均明显改善,未出现手术相关并发症。5例患者平均随访9．2（2～17）个月,无新发临床症状。结论弹簧圈辅助支架治疗VBD在技术上具有可行性,安全性较好,可显著改善VBD引起的多种临床症状,但对卒中的长期预防效果尚有待进一步研究。     

37例基底动脉狭窄病人行支架置入血管成形术临床特点分析

目的观察基底动脉狭窄病人行支架置入血管成形术的临床特点。方法回顾性分析37例基底动脉狭窄病人行支架置入血管成形术的临床资料。结果 37例病人共放置支架42枚,其中椎-基底动脉结合部4枚,基底动脉37枚,未见颅内出血发生;Winspan支架24枚,APPOLO等球扩支架13枚;发生不良血管事件3例,其中手术距发病时间<2周1例,>2周2例,WINSPAN治疗1例,APPOLO治疗2例,发生时间于术后48h内2例,>48h1例。结论基底动脉狭窄病人行支架置入血管成形术应严格掌握适应症,分清患者的发病机制,掌握合适的治疗时机,根据病变血管的部位、长度、分支状况及血管通路选择合适的支架治疗。     

不同病理机制急性椎基底动脉闭塞患者临床特征及血管内治疗效果比较

目的比较颅内动脉粥样硬化疾病(ICAD)和栓塞两种病理机制导致的急性椎基底动脉闭塞(AVBO)患者临床特征及血管内治疗效果。方法选取2019年1月至2021年11月在南阳市中心医院接受血管内治疗的116例AVBO患者,根据病理机制将其分为ICAD组72例和栓塞组44例。收集并比较患者术前资料(包括一般资料、临床资料)、术中血管造影检查结果〔闭塞位置、急性基底动脉闭塞侧支循环血管造影评分(ACGS-BAO)〕、术后即刻血管再通成功情况、围术期症状性颅内出血发生率和预后情况。结果两组患者性别、年龄和有高血压史、糖尿病史、心房颤动史、卒中史、吸烟史者占比及美国国立卫生研究院卒中量表(NIHSS)评分、后循环Alberta卒中项目早期CT评分(ASPECTS)、基底动脉计算机扫描血管造影评分(BATMAN)、静脉溶栓率、发病至入院时间比较,差异无统计学意义(P>0.05);ICAD组患者格拉斯哥昏迷量表(GCS)评分低于栓塞组(P<0.05)。两组患者血管闭塞位置比较,差异有统计学意义(P<0.05);ICAD组闭塞部位常见于椎动脉V4段、基底动脉中段,栓塞组闭塞部位常见于基底动脉上段。ICAD组患者ACGS-BAO高于栓塞组(P<0.05);两组患者术后即刻血管再通成功率、围术期症状性颅内出血发生率、预后良好率比较,差异无统计学意义(P>0.05)。结论ICAD可能是AVBO患者更常见的病理机制,病理机制为ICAD的AVBO患者术前GCS评分可能低于病理机制为栓塞者,且前者的闭塞位置常见于椎动脉V4段、基底动脉中段,后者的闭塞位置常见于基底动脉上段。两种不同病理机制的AVBO患者经血管内治疗后血管再通成功率和预后良好率相当。     

血管内治疗椎-基底动脉夹层动脉瘤的疗效分析

目的探讨血管内治疗椎-基底动脉夹层动脉瘤的效果。方法回顾性分析北京市海淀医院和首都医科大学宣武医院2013年8月至2014年9月入院治疗的40例椎-基底动脉夹层动脉瘤患者的临床资料,并对其进行临床症状及影像学随访。按治疗方式分为支架辅助弹簧圈栓塞组(A组,34例)和载瘤动脉闭塞组(B组,6例),并根据术后1年的临床症状及影像学随访评价疗效。结果术后随访1年,A组患者改善29例(85.3%),稳定1例(2.9%),进展4例(11.8%),4例进展患者死于脑梗死并发症(术后1周至半年);B组6例患者均较术前改善,未发生颅内出血及缺血事件。结论采用支架辅助弹簧圈栓塞技术和载瘤动脉闭塞技术治疗椎-基底夹层动脉瘤相对安全有效。     

颅内支架重叠技术治疗未破裂椎-基底动脉夹层动脉瘤

目的探讨颅内支架重叠技术在未破裂椎-基底动脉夹层动脉瘤（VBDAs）治疗中的临床效果。方法回顾性分析10例VBDAs患者,共12个未破裂VBDAs。运用颅内支架重叠技术,采用LEO支架进行治疗（对9例患者采用2枚支架,1例采用3枚支架）,通过改变动脉瘤腔的血流动力学栓塞动脉瘤,并保留载瘤动脉。所有患者均完成临床和影像学随访。结果①影像学检查表现分别为近端狭窄、串珠样变、波纹状、双腔征、壁间血肿。②术后即刻造影均显示,动脉瘤腔内对比剂滞留。1例患者术中支架移位,但未导致神经功能障碍。2例患者术后出现短暂性脑缺血发作,对症治疗后缓解。其余患者未出现神经系统并发症。出院前头部CT检查均未见新发脑梗死。③术后6个月造影结果显示,6个夹层动脉瘤完全闭塞,6个夹层动脉瘤部分闭塞。临床随访8～27个月,10例患者的最终改良Rankin评分均为0分,随访中患者均未出现该技术相关的并发症。结论颅内支架重叠技术治疗未破裂VBDAS是安全和有效的。     

血管内支架植入术治疗椎基底动脉重度狭窄患者23例临床分析

目的探讨血管内支架植入术治疗椎基底动脉重度狭窄的临床效果。方法对2012年1月至12月我院收治的椎基底动脉重度狭窄患者23例进行血管内介入治疗,观察手术成功率,患者术后狭窄率及脑血管狭窄症状改善情况。结果 23例患者全部手术成功,手术成功率为100%;患者狭窄率由术前(81.6±9.2)%下降为术后的(21.9±8.4)%。术后随访2~10个月,1例患者再发血管狭窄,与未正规应用抗血小板聚集药物有关;其余患者脑血管狭窄症状均有明显改善。结论应用血管内支架植入术治疗椎基底动脉重度狭窄具有较好的临床效果及安全性,但长期疗效需进一步研究观察。     

椎基底动脉支架成形术后支架内再狭窄的相关危险因素分析

目的：探讨椎基底动脉支架成形术后再狭窄（ISR）的危险因素,为防治椎基底动脉内支架成形术术后ISR提供依据。方法选取2008年2月1日至2012年2月1日在我院确诊的椎基底动脉狭窄患者55例,对其椎基底动脉内支架成形术及术后常规彩色多普勒超声（CDI）、计算机断层扫描血管造影（CTA）或数字减影血管造影（DSA）检查,随访结果并进行回顾性分析。使用单因素和Logistic多因素回归分析方法进行了统计学分析。结果55例患者有65处椎基底动脉狭窄,共置入支架65枚,术中1例出现后循环急性梗死,经治疗后好转出院,技术成功率98.18％（54/55）,血管术前狭窄（74.24±12.90）％降至术后（2.69±5.30）％（ P＜0.05）,术后残余狭窄≤20％。平均随访时间为（24.16±13.94）个月（3个月-4年）,CDI随访25例,CTA随访23例,DSA随访7例。共12例患者13处支架（13/65,20％）出现血管直径缩短≥50％的ISR。经多因素Logistic回归显示2型糖尿病、病变血管成角扭曲致ISR发生的相对危险度（RR ）分别为7.59,6.70。结论2型糖尿病、病变血管成角扭曲是椎基底动脉内支架成形术后ISR的独立危险因素。     

血管内机械再通治疗急性基底动脉闭塞的疗效分析

目的探讨机械再通治疗急性基底动脉闭塞患者的近期疗效。方法回顾性分析12例基底动脉急性闭塞并接受支架辅助血管内再通治疗的患者资料。对8例患者使用Apollo或Wingspan支架,4例使用Solitaire AB支架。血管内介入治疗后按照脑梗死溶栓等级系统(TICI)分级评定血管再通情况。评估3个月后的临床结局。结果①基底动脉远段闭塞3例,近段闭塞4例,椎动脉颅内段延伸至基底动脉近段闭塞3例,基底动脉全程闭塞2例。术前美国国立卫生研究院卒中量表(NIHSS)评分的中位数为20(15～24)分。②血管内机械再通治疗的技术成功率为100%,10例达到充分再通标准。2例患者术中发生血管痉挛,无临床症状。1例发生症状性颅内出血。③患者出院时NIHSS评分中位数为10(4～22)分,同最初NIHSS评分相比,7例患者NIHSS评分改善≥5分。④4例术后3个月的功能转归良好,死亡3例。结论血管内机械再通治疗急性基底动脉闭塞具有较高的再通率,可改善3个月时的临床结局。针对基底动脉闭塞不同病因需要个性化的血管内治疗方法。     

双支架并联取栓术治疗急性基底动脉闭塞初步研究

目的初步探讨双支架取栓治疗急性基底动脉闭塞患者的可行性、有效性及安全性。方法回顾性分析采用Solitaire FR双支架并联取栓术治疗血栓负荷重的急性基底动脉闭塞所致脑梗死5例患者,统计手术时间,评价取栓后即刻血流再灌注、24 h神经功能改善及术后90天随访mRS评分。结果 5例患者均通过双支架并联取栓术获得闭塞血管良好再通,改良脑梗死溶栓分级(mTICI)为2b-3级,其中完全再通4例(mTICI 3级)。无明显与操作相关并发症,术后24 h NIHSS评分较术前减少10分。术后90天随访,2例患者预后良好,2例残疾,1例患者死亡。结论使用Solitaire FR双支架并联取栓术治疗血栓负荷重的部分后循环急性脑梗死患者是安全有效的。     

An experience of the use of stents with drug coating in patients with long and diffuse coronary artery lesions

Treatment of long and diffuse lesions of coronary arteries remains one of most complicated sections of endovascular treatment. From 2003 to 2005 treatment with the use of stents with drug coating was conducted in 198 patients with long and diffuse coronary artery lesions. This made up 26% of total number of patients subjected to percutaneous coronary intervention during this time. Mean age of patients was 58 +/- 11 years, 164 (83%) of them were men, 37 (19%) had chronic occlusions of coronary arteries, in 91 (46%) side branches went out from the damaged segment. Patients were divided in two groups: 1st (n=136) comprised patients with lesion length from 22 to 33 mm, 2nd consisted of patients in whom lesion length exceeded 33 mm. Control group comprised 54 patients with lesion length less than 23 mm subjected to endovascular treatment with the use of stents with drug coating during same period of time. Average length of stented segment was 27.3 +/- 3.6 mm in the first group, 44.5 +/- 9.8 mm in the second group and 14 +/- 3.6 in the control group. Immediate success of the procedure was somewhat lower in group II compared with group I (87 and 91%, respectively). Hemopericardium and cardiac tamponade requiring urgent surgery developed in 2 group II patients (3.2%) during first 2 hours after attempt of recanalization of long chronic occlusions of the anterior descending artery. One patient (1.6%) had small-focal myocardial infarction after procedure, in another patient (1.6%) subacute occlusion developed after stenting of venous graft to the right coronary artery which we failed to eliminate. In the first group in 2 patients (1.4%) small-focal myocardial infarction developed. There were no complications in the control group. In 8 months after procedure angiographic restenosis developed in 6 patients (5%) in the 1st group, in 4 (8%) in the second and in 1 (2%) in the control group, however differences were not significant. Rates of repeat revascularizations of the target stenosis were 3, 5 and 0%, respectively. Of 10 cases of restenosis in patients with long stenoses in 5 cases restenosis was located inside stent and was focal (length less than 10 mm), in 3 cases it was located proximal or distal to stent, and in 2 patients manifested as complete occlusion of the stented segment. Treatment of long and diffuse lesions with the use of stents with drug coating appears safe and effective. Overall rate of development of perioperative complications is higher in treatment of stenoses longer than 33 mm compared with stenoses with length 23-33 cm (6.4 vs. 1.4%). Probability of restenosis and repeat revascularization of target stenosis after 8 months is not high.     

颈动脉内膜切除术治疗颈动脉次全或完全闭塞的术后再通超声评估

目的应用血管超声对颈动脉次全或完全闭塞病变行颈动脉内膜切除术(CEA)后再通患者的近、远期效果进行评估。方法回顾性连续纳入2005年1月—2014年1月在首都医科大学宣武医院经DSA确诊为颈动脉闭塞性病变,并接受CEA治疗的患者共107例,其中次全闭塞(颈动脉狭窄率95%~99%)63例,完全闭塞44例。记录所有患者围手术期并发症的发生情况。随访采用门诊随访、电话跟踪的方式,超声随访手术再通患者术后1周及3、6、12、24个月的情况,记录CEA术后患者临床预后、血管再狭窄、血管结构及血流动力学的改变。结果 (1)107例患者手术后再通86例(80.4%),未通21例(19.6%)。术后30d内卒中及死亡发生率为4.7%(5例),其中次全闭塞组发生率为4.8%(3例),完全闭塞组为4.5%(2例)。(2)术后1周内再通患者的患侧大脑中动脉收缩期峰值血流速度(PSV)、舒张期末血流速度(EDV)及血管搏动指数均较术前明显升高[分别为(120±39)cm/s比(60±17)cm/s,(50±18)cm/s比(33±11)cm/s和0.96±0.20比0.67±0.14]差异有统计学意义(均P0.01);颈动脉超声显示再通患者原病变局部血管内径均较术前增宽[分别为(4.4±1.1)和(3.6±1.0)mm)],差异有统计学意义(P0.01)。(3)超声随访颈动脉再通患者69例,时间为1~60个月,中位数为12个月。术后1~6个月血管通畅比率95.6%(66例),6~12个月血管通畅比率94.2%(65例),12~24个月血管通畅比率94.2%(65例),2年以上血管通畅比率91.3%(63例)。结论血管超声可对颈动脉闭塞性病变CEA后血管再通患者进行近期及远期的跟踪随访,判断血流改善程度,及时发现术后再狭窄。     

支架成形术治疗不同Mori分型椎-基底动脉重度狭窄的研究

目的评价对不同Mori分型的椎-基底动脉重度狭窄患者行支架成形术的疗效及早期预后。方法回顾性分析18例症状性椎-基底动脉重度狭窄患者的资料,按照Mori分型采用球囊扩张支架和自膨式支架行支架成形术,比较不同Mori分型的椎-基底动脉重度狭窄患者在支架选择、同手术期并发症及早期预后的情况。结果①按Mori分型,18例患者中MoriA型8例,MoriB犁4例,MoriC型6例。②对MoilA型和MoriB型患者均选用球囊扩张支架,MoriC型1例患者选用球囊扩张支架,5例选用Wingspan自膨式支架。支架成形术的技术成功率均为100％。③术后第2天和术后第30天复查TCD,显示支架内血流通畅,均未出现再狭窄。④除1例MoriC型患者于术后24h脑桥有少量出InL之外,其余患者围手术期均未出现手术相关并发症,也未出现神经系统新发症状。⑤17例出现眩晕症状的患者中,14例术后症状消失,其中MoriA型6例,MoriB型3例,MoriC型5例。结论在支架成形术中,对MoriA型、MoriB型椎-基底动脉重度狭窄患者可选用球囊扩张支架,MoriC型患者可选用Wingspan支架。支架成形术治疗椎-基底动脉重度狭窄是安全有效的,早期预后良好,长期疗效仍需进一步观察。     

Stenting of stenotic or occluded iliofemoral veins,superior and inferior vena cavae in children with congenital heart disease: Acute results and intermediate follow up

Objectives:

To determine the short and intermediate term outcome following systemic venous stent placement in children with congenital heart disease.

Background:

Patients with congenital heart disease are at risk of stenosis or occlusion of systemic veins following indwelling lines or catheterizations. Stent dilation may ameliorate symptoms and open the vessel for use during future procedures. We report our acute and intermediate results.

Methods:

All patients with systemic venous stent placement in the iliofemoral veins, inferior or superior vena cava at our institution between 1998 and 2006 were included. Initial and the follow‐up catheterization data were reviewed retrospectively.

Results:

70 stents were placed in 33 patients (36 vessels). Median age was 2.6 years (0.2–14.2) and weight 11.5 kg (3.8–78.7). 17/36 vessels (47%) were occluded requiring recanalization. Following stent delivery, the mean minimum vessel diameter increased from 3.1 ± 3.2 to 7.2 ± 3.0 mm (P < 0.001). There were no major complications. Seventeen patients and vessels had a total of 62 follow‐up catheterizations, with median length of follow‐up 4.1 years (0.7–9.3). During intermediate follow up, 7/17 vessels (41%) required additional intervention. Six patients had additional balloon dilation of existing stents, and one additional stent was placed. Vessels were further dilated to 8.4 ± 3.5 mm at the last catheterization.

Conclusion:

Systemic venous stents are safe and effective in recanalizing stenosed or occluded vessels. At follow‐up, reocclusion can occur, however, previously placed stents can be safely recanalized if necessary. Future studies will determine if stenting is indicated in a broader population. © 2009 Wiley‐Liss, Inc.     

Bare nitinol stent enabled recanalization of long-segment, chronic total occlusion of superficial femoral and adjacent proximal popliteal artery in diabetic patients presenting with critical limb ischemia

PurposeTo evaluate our experience of limb salvage with bare nitinol stent enabled recanalization of long length occlusions of superficial femoral artery (SFA) and adjacent proximal popliteal artery (PPA) in diabetic patients.MethodsA total of 573 patients underwent 842 lower limb interventions from August 2006 to September 2008 at our institute. A retrospective review was done of diabetic patients undergoing recanalization of long length SFA/adjacent PPA (>10 cm) occlusions with self expanding bare nitinol stents evaluating their impact on limb salvage.ResultsForty-four patients (mean age 65.2 years, M:F 25:19) underwent 49 long-length (>10 cm) SFA/PPA stenting procedures over a period of 26 months. Diabetics comprised 66% of patients (n=29, mean age: 63.7 years, M: F 19:10). The infrapopliteal distal run-off in this diabetic subgroup comprised one vessel (n=14/29, 48%), two vessels (n=12/29, 41%), and three vessels (n=3/29, 10%). The spectrum of critical limb ischemia included rest pain (n=8), ulcer (n=7) and gangrene (n=14). The lengths of occlusions recanalized were 10–39 cm. A total of 58 stents (individual length 10–17 cm, average diameter 6 mm, mean 2 stents per patient) were placed with average length of stented segment being 23.8 cm. Four patients had stents placed through ipsilateral popliteal artery approach with rest placed through femoral artery approach. Significant complications of the procedure included distal embolization (n=3) successfully managed with thrombolysis and popliteal arteriovenous fistula in one patient undergoing recanalization through popliteal approach, managed with covered stent placement. No procedure related mortality occurred during thirty-day follow-up period. All were followed up over an average duration of twelve months post-procedure. Three patients died due to associated medical conditions during this period. The following amputations were done on follow-up (three toe amputations, five forefoot amputations, three below-knee amputations, two above-knee amputations). The overall limb salvage rate was 80%.ConclusionOur study shows beneficial result of SFA/PPA stent placement in diabetic occlusions with significant concomitant infrapopliteal disease.     

Short-Term Results and Intermediate-Term Follow-Up of Laser Wire Recanalization of Chronic Coronary Artery Occlusions: A Single-Center Experience

Objectives. This study sought to elucidate the short-term efficacy and intermediate-term outcome of excimer laser recanalization of chronic coronary artery occlusions in patients in whom attempts at mechanical revascularization had failed.

Background. Recanalization of chronic coronary occlusions with the use of a mechanical guide wire fails in 30% to 50% of cases, mostly because of inability to pass the wire through the lesion. The value of using excimer laser energy in this setting has not yet been determined.

Methods. The study group comprised 66 consecutive patients with 68 chronic coronary occlusions. Patients were eligible for inclusion in the study if a previous attempt at mechanical revascularization had failed and if their angiographic status was such that 1) the vessel segment distal to the occlusion could be visualized by way of collateral vessels, 2) the entry point of the occlusion was clearly outlined, and 3) not more than one anatomic bend was expected within the occlusion. Excimer laser energy was applied to the lesion through a 0.018-in. (0.046 cm) fiber-optic guide wire. Adjunctive balloon angioplasty and stenting were performed in all successfully treated patients but one.

Results. Thirty-four occlusions (50%) in 32 patients (48%) could be crossed with the laser wire. Location and age of the occlusion had no adverse influence on the outcome of laser wire recanalization, nor did the presence of bridging collateral vessels, a major side branch at the site of the lesion or a blunt stump of the occlusion. An inverse relation was found between the success rate and the length of the occlusion, such that a 19% reduction of the success rate accompanied each 10-mm increment of the mean occlusion length. Thus, the success rate was 68% for lesions ≤10 mm but only 25% for lesions >30 to ≤40 mm. The presence of a bend in the lesion exceeding 60° was strongly related to procedural failure. During a median angiographic follow-up period of 18 weeks, restenosis >50% (n = 6) or reocclusion (n = 4) was found in 10 of the 32 successfully treated patients, for an intermediate-term success rate of 33% (22 of 66). Clinical follow-up revealed improved anginal status in 21 patients (66%) after a median of 24 weeks. Major complications (death, myocardial infarction, emergency operation) were not encountered.

Conclusions. Successful recanalization of a chronic coronary occlusion by using currently available laser wires can be expected in 50% of selected patients in whom attempts at mechanical revascularization fail. Restenosis or reocclusion accounts for an overall 6-month success rate of 35%.     

颅内大动脉慢性闭塞血管内再通的可行性和安全性分析

目的探讨血管内介入再通颅内大动脉慢性闭塞的可行性和安全性。方法回顾性分析2009年1月至2017年1月首都医科大学宣武医院神经外科血管内介入再通的15例颅内大动脉慢性闭塞患者的临床和影像学资料。12例为椎动脉V4段闭塞,3例为颈内动脉颅内段闭塞。术前采用全脑DSA评估闭塞长度和位置,用高分辨率MRI评估闭塞性质和再通可行性;术中双侧股动脉置鞘13例,一侧用于再通置入支架,另一侧通过侧支循环代偿充盈闭塞动脉远端作为参考路径图,增加再通可行性。术后根据脑梗死溶栓(TICI)分级系统评估再通后的顺向血流,定义≥2b级为血管成功再通。结果 15例患者首次症状发作到再通时间中位数为50(18~365)d。再通成功13例,2例椎动脉颅内段再通失败。13例再通成功患者中,12例再通后复查造影正向血流恢复至TICI 3级,1例TICI 2b级;7例症状好转,4例症状无变化,1例术后出现短暂性脑缺血发作、1例出现卒中。11例患者随访中位数时间39(3~89)个月后,改良Rankin量表评分中位数为1(0~2)分。结论颅内大动脉慢性闭塞再通,术前采用高分辨率MRI评估以及术中双侧置鞘技术,可能会增加开通率和降低围手术期并发症。     

动脉内溶栓联合血管成形术治疗发病六小时内椎-基底动脉系统缺血性卒中患者的疗效

目的探讨动脉内溶栓联合血管成形术治疗椎-基底动脉系统缺血性卒中6 h内患者的疗效及安全性。方法收集2006年4月—2012年2月椎-基底动脉系统急性缺血性卒中（发病时间〈6 h）患者21例,根据所用治疗方式的不同分为单纯动脉内溶栓组（10例）和动脉内溶栓联合血管成形术组（联合治疗组,11例）。联合治疗组中4例行球囊扩张和支架置入术,1例行支架置入术,6例仅行球囊扩张术。根据急性心肌梗死溶栓标准（TIMI）判定血管再通情况。采用美国国立卫生院卒中评分（NIHSS）评价治疗前后的神经功能。根据改良Rankin量表（mRS）评估溶栓后3个月的疗效。结果①单纯溶栓组6例患者的血管再通,其中1例（10.0%）为完全再通,联合治疗组有7例血管再通,其中6例（54.5%）为完全再通,完全再通率差异有统计学意义,P〈0.05。②经治疗后,单纯溶栓组和联合治疗组的NIHSS评分均下降,但是两组患者的术后即刻、术后24h和术后2周的NIHSS评分比较,组间差异无统计学意义。③两组均有3例患者死亡。治疗3个月后,存活的患者中,单纯溶栓组疗效良好的有4例,疗效差的有3例;联合治疗组分别为5例和3例。两组比较,病死率及疗效差异无统计学意义。④成功施行支架置入术的5例患者,血管均得到完全再通,术后随访未见再狭窄。而动脉溶栓联合单纯球囊扩张的6例患者中,仅2例获再通（1例为完全再通）,其中1例术后3个月发生再狭窄。结论对于行单纯动脉内溶栓血管不能再通的椎-基底动脉系统急性缺血性卒中患者,联合血管内成形术可提高血管再通率;支架置入术较单纯球囊扩张术疗效可能更佳。