血管支架成形治疗颅内动脉狭窄的系统评价

Systematical evaluation of vascular stenting for intracranial arterial stenosis

目的:对已公开发表的支架成形治疗症状性颅内动脉狭窄的文献进行系统评价,以评估支架围置入期安全性、成功率和预后方面的效果。方法:对EMbase(1980/2008-12)、MEDLINE(1966/2008-12)和中国生物医学文献数据库(CBM,1978/2008-12)、中文学术期刊全文数据库(CNKI)进行检索,筛查相关文章的参考文献,并对脑血管病杂志及相关文章的参考文献进行手工检索。对脑血管支架置入后的动物实验加以整理;对脑血管支架置入后的临床实验加以整理,结合其随访和功能评价等方面,进行脑血管支架植入后生物相容性的观察研究。结果:从15篇有关脑血管支架置入的动物实验选出5篇,实验结论显示多种形式的支架可以起到良好的治疗血管狭窄和预防血管再狭窄的作用,且生物相容性良好,可以作为临床选用支架的参考。确定相关脑血管支架置入的临床试验文献15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476例;平均置入成功率达96.9%;置入后30d内临床终点事件发生率为11.42%,30d后1年内累积主要终点事件发生率为0.58%。结论:支架成形治疗症状性颅内动脉狭窄有效性及安全性均较高,值得推广应用。

OBJECTIVE： To systematically evaluate the literature regarding stenting for symptomatic intracranial arterial stenosis so as to evaluate the perioperative safety, success rate and prognosis outcome of stenting. METHODS： Computer-based online search of EMbase （1980/2008-12）, M EDLIN E （1966/2008-12）, CBM （1978/2008-12） and （CNKI） was performed to screen related articles. The reference of cerebrovascular disease journals and related articles was manually searched. The animal experiments of cerebrovascular stent were summarized; the clinical experiments of cerebrovascular stent were summarized to analyze the biocompatibility following stenting in combination with follow up and functional evaluation. RESULTS： Of 15 animal experiments, 5 were selected. Results show that various types of stent have favorable effect on vascular stenosis and restenosis with good biocompatibility, which could serve as reference of clinical stent. A total of 15 clinical experiment of cerebrovascular stent was included and combined with patients in our hospital, involving 476 cases; the success rate of implantation was 96.9%; the incidence of clinical events within 30 days after implantation was 11.42%, and the incidence of main end events from 30 days to 1 year was 0.58%. CONCLUSION： Stenting treatment for symptomatic intracranial arterial stenosis is effective and safe.