血管内支架成形术治疗症状性颅内动脉狭窄的系统评价

Stent-assisted Angioplasty for Symptomatic Stenosis of Intracranial Arteries:a Systematic Review

目的对已发表的支架成形术治疗症状性颅内动脉狭窄的文献进行系统评价,以评估支架成形术在预防卒中复发、死亡、其他血管事件方面的效果及安全性。方法对国内外医学文献数据库进行检索,并对脑血管病杂志和相关文献后参考文献进行手工检索。结果确定相关的文献21篇并结合本单位治疗病例,共包含症状性颅内动脉狭窄患者1432例,未见有随机对照研究报道;平均手术成功率达96.61%;30d内临床终点事件发生率为12.53%,30d后1年内累积主要终点事件发生率为5.97%。支架成形术后再狭窄的发生率为0%～32.4%。结论支架成形术治疗症状性颅内动脉狭窄技术上是可行的,支架置入成功者具有较好的预后,但围手术期的死亡率和致残率较高。

Objective To assess the efficacy and safety of stent-assisted angioplasty for symptomatic stenosis of intracranial arteries. Methods The databases including Medline, EMBASE, Pubmed and CMBase, and reference lists of relevant articles from the Journals of cerebrovascular diseases were searched respectively by computer and manual method. Results No relevant randomized control trial was found. A total of 1 168 patients with symptomatic stenosis of intracranial arteries were reported in 21 articles related to stent-assisted angioplasty and 264 patients with symptomatic stenosis of intracranial arteries received stent-assisted angioplasty in our department. The successful rate of stent-assisted angioplasty for intracranial artery stenosis was 96.61%.The probability of primary endpoint within 30 days was 12.53%, and the cumulative probability of ischemic stroke, hemorrhagic stroke and death after 30 days was 5.97%. The rate of restenosis after stent-assisted angioplasty ranged from 0 to 32.4%. Conclusions The endovascular stenting for intracranial artery stenosis is feasible, but it may produce higher mortality and disabled rate. The prognosis is good in the patients with symptomatic stnosis of intracranial arteries in whom the stent-assisted angioplasty is successfully performed.