药物洗脱支架治疗颅内动脉及颅外椎动脉狭窄

Drug-eluting stent implantation for the percutaneous treatment of stenosis in intracranial arteries and extracranial vertebral arteries

目的总结药物洗脱支架治疗脑供血动脉狭窄的经验,以探讨其短中期疗效、安全性及预防再狭窄的作用。方法在局麻或全麻下,采用直接支架成形术,治疗53例反复TIA或脑梗死后恢复良好、狭窄程度>50%且常规药物治疗无效的病人。术后常规抗血小板聚集治疗,并定期进行临床和影像学随访。结果53例病人共55处脑动脉狭窄,其中颅内动脉47处,颅外动脉8处。均采用药物洗脱支架进行治疗。51例共53处狭窄成功植入药物洗脱支架(Cypher支架51枚,Taxus支架2枚)。平均狭窄程度从术前(74.5±6.7)%减少至(8.7±4.4)%。3例发生穿支血管闭塞症状。术后随访2￣14个月,仅1例病人因再狭窄复发TIA,其他病人无TIA或卒中复发。血管造影随访3￣12个月,平均6.4个月,共30例(56.6%),1例发生支架内再狭窄,2例支架近端轻度狭窄(<50%)。结论药物涂层支架治疗脑供血动脉狭窄是安全有效的。与裸支架比较,药物涂层支架能显著降低支架内再狭窄的危险;但长期疗效有待于进一步观察。

Objective To summarize the experience of the angioplasty of intracranial stenosis and extracranial vertebral artery stenosis with drug-eluting stent （DES）, and evaluate the safety, early and mid-term outcomes and preventive effect against restenosis. Methods Primary stenting under local or general anesthesia was given to 53 patients who well recovered from recurrent transient ischemic attack （TIA） with cerebral infarction larger than 50% in intracranial arteries and extracranial vertebral arteries. Conventional antiplatelet therapy was adopted after the surgery. The regular follow-up included collection of clinical and vascular imaging materials. Results Among 55 stenoses in 53 patients, stenoses located in intracranial arteries in 47 lesions, extracranial vertebral arteries in 8. Fifty-one patients with 53 lesions were successfully treated with drug-eluting stent （51 Cypher stents and 2 Taxus stents）. The mean degree of stenosis reduced from （74.5±6.7）% to （8.7±4.4）%. Three cases had ischemic events related to perforating arteries. During follow-up for 2-14 months, the patients were clinically asymptomatic and had no recurrent TIA or stroke, except 1 TIA with restenosis. Angiographic follow-up of 3-12 months was obtained in 30 patients （56.6%） with a mean of 6.4 months. Restenosis inside the stent was observed in 1 patient and in at the proximal end of the stent in 2. Conclusion The safety and effectiveness of using the DES in cerebrovascular diseases is confirmed. Compared with the bare stent, DES can present with significant lower risk ofrestenosis. But long-term follow-up is needed for the observation of the therapeutic effect.