Hasanali DURMAZ, Onur ERGUN, Erdem BİRGİ, İhsan YALÇINKAYA, Işık CONKBAYIR

Vertebral arter darlıklarında endovasküler tedavi

Amaç: Vertebral arter darlığı olan hastalarda endovasküler stent tedavisinin endikasyon, teknik başarı, güvenilirlik ve etkinliğinin tartışılması amaçlandı. Gereç ve Yöntem: Haziran 2012 ve Aralık 2018 tarihleri arasında vertebral arter darlığı tanısı ile endovasküler stent yerleştirilen 10 hastanın (3 kadın, 7 erkek) medikal kayıtları retrospektif olarak incelendi. Hastaların ortalama yaşı 63.9 yıl idi (aralık: 47−78 yıl). Hastalara, mevcut semptomları, klinik öykü ve dijital subtraksiyon anjiyografi sonrası vertebral arter darlık oranına göre endovasküler stent tedavisi uygulandı. İşlemler lokal anestezi altında gerçekleştirildi. Bulgular: Çalışmaya dahil edilen dokuz hastada (%90) %50’nin üzerinde vertebral arter orjin (V0) ve proksimal (V1) darlık saptanmış olup ortalama darlık oranı %65 olarak hesaplanmıştır. %50’nin altında darlık bulunan bir hastada baş-boyun kitlesinin neden olduğu bası ve invazyon nedeniyle profilaktik amaçlı kaplı stent uygulandı. Hastaların sadece birinde subklavian arterde yumuşak plak bulunması ve buna bağlı distal emboli riski nedeniyle distal koruyucu filtre sistemi kullanıldı. Ortalama stent uzunluğu ve çapı sırasıyla 21.8 mm (aralık: 12-39 mm) ve 4.5 mm (aralık: 4-6 mm) hesaplandı. İşlem sonrası tüm hastalarda yeterli lümen açıklığı sağlandı ve teknik başarı %100 olarak kabul edildi. Sonuç: Sonuç olarak vertebral arter darlıklarının endovasküler tedavisi, özellikle medikal tedavi başarısız ya da yetersiz olan hastalarda düşük komplikasyon oranları ve yüksek teknik başarı ile güvenli ve etkili bir tedavi yöntemidir.

Objective: It is aimed to discuss the indications, technical success, reliability and efficacy of endovascular stent therapy in patients with vertebral artery stenosis. Material and Methods: A total of 10 patients (3 females, 7 males) who underwent endovascular stent with vertebral artery stenosis between June 2012 and December 2018 were evaluated retrospectively. The mean age of the patients was 63.9 years (range: 47-78 years). Endovascular stent treatment was performed according to the symptoms, clinical history and degree of vertebral artery stenosis obtained by digital subtraction angiography. The procedures were performed under local anesthesia. Results: In nine patients included in the study (90%), stenosis more than 50% of the vertebral artery origin (V0) and proximal (V1) were detected and the mean stenosis rate was calculated as 65%. In a patient with stenosis under 50%, covered stent was applied due to compression and invasion caused by head and neck mass. The distal protection device was used in only one patient due to the presence of soft plaque in the subclavian artery. The mean stent length and diameter were 21.8 mm (range: 12-39 mm) and 4.5 mm (range: 4-6 mm), respectively. After the procedure, adequate luminal patency was achieved in all patients and the technical success was accepted as 100%. Conclusion: In conclusion, endovascular treatment of vertebral artery stenosis is a safe and effective treatment method with low complication rates and high technical success especially in patients with failed or insufficient medical treatment.

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