Wingspan支架治疗症状性颅内动脉狭窄的围手术期临床疗效观察

Wingspan stent system for treatment of symptomatic intracranial atherosclerotic stenosis:short-term outcomes

目的 观察Gateway—Wingspan支架系统治疗症状性颅内动脉狭窄的安全性，以及防治脑缺血事件发生的围手术期效果。方法 应用Gateway—Wingspan支架系统行血管成形术治疗药物治疗无效的症状性颅内动脉狭窄患者27例（29处）。29处狭窄中17处位于后循环，12处位于前循环。观察狭窄的部位、治疗前后的狭窄率、治疗成功率、治疗相关并发症的发生情况和转归、术后患者症状改善的状况，术后30d通过电话或门诊随访缺血性事件的发生情况。结果 术前平均狭窄程度为71．8％（56.0％-87．8％），术后残留狭窄率为24．9％（0—45％）。治疗成功率为100％。4例患者出现并发症，其中3例为病变相关性穿支动脉梗塞，1例为非病变相关性梗塞，无出血性并发症。并发症发生率为14．8％，致残率为7．4％，严重致残率为3．7％，死亡率为0。术后30d内患者症状均有所好转，无新出现的脑缺血事件。结论 应用Gateway-Wingspan支架系统治疗颅内动脉狭窄安全，其围手术期临床效果较好，长期疗效需进一步观察。

Objective To observe the safety of the Wingspan Stent System with Gateway PTA Balloon Catheter in the treatment of symptomatic intracranial atherosclerotic stenosis and the short-term outcomes in the prevention and treatment of cerebral ischemic events. Methods Symptomatic intracranial atherosclerotic stenosis in 27 patients （29 sites） who had angioplasty and had no response to medication were treated with the Wingspan Stent System with Gateway PTA Balloon Catheter. 17 of the 29 stenosis were in the posterior cerebral brood circulation, and 12 were in the anterior circulation. The location of stenosis, severity of stenosis pre-and post-treatment, successful rate of treatment, occurrence of treatment- related complications, outcomes, and symptom improvement of patients after stenting were observed. The occurrence of ischemic events were followed-up after stenting by telephone or outpatient follow up 30 days after stenting. Results The average degree of stenosis before stenting was 71.8% （ 56. 0% -87.8% ）, the residual stenosis after stenting was 24.9% （0-45%） , and the successful rate of treatment was 100%. Four patients had complications, 3 of them had lesion-related perforating artery infarction, and one had non-lesion-related infarction. There was no hemorrhagic complication. The incidence of complication was 14. 8%, severe morbidity was 3.7%, and mortality was 0%. The patients＂ symptoms improved gradually within 30 days after stenting, and no new ischemic event occurred. Conclusion The Wingspan Stent System with Gateway PTA Balloon Catheter for the treatment of symptomatic intracranial atherosclerotic stenosis is safe. Its short-term clinical efficacy is good, and its long-term efficacy needs to be further observed.