Neuroform自膨支架置入治疗症状性椎-基底动脉狭窄的疗效观察

Neuroform self-expanding stent for treatment of symptomatic intracranial vertebrobasilar arterial stenosis

目的：观察应用新型颅内支架Neuroform治疗症状性椎-基底动脉狭窄的有效性和安全性。方法：选择北华大学附属医院神经外科及宣武医院神经外科收治的37例颅内椎-基底动脉狭窄患者,经内科抗凝和抗血小板聚集治疗无效,男24例,女13例,年龄49-72岁,平均64岁。均采用微导管技术进行血管造影,行经皮血管内支架置入,接受了Neuroform颅内专用支架治疗。结果：全部例患者椎动脉狭窄和基底动脉狭窄的狭窄率从术前平均84%下降到24%,技术成功率达100%,37例患者随访时间6-22个月,平均13个月。病变动脉的狭窄程度纠正50%-90%。无血管撕裂、急性动脉闭塞、远端血管栓塞事件等并发症出现,术后1例出现完全闭塞,但无明显临床症状。3例同时置入2枚支架,其中双侧椎动脉狭窄1例,右侧椎动脉及基底动脉狭窄2例。1例患者术后3d,因未服用抗血小板聚集药物,出现支架内急性血栓形成,经给予急诊溶栓治疗后完全恢复。支架置入后电话及门诊随访临床症状均获得不同程度改善,尚未有病情加重回报。结论：Neuroform自膨式颅内专用支架的应用,有效缓解了椎-基底动脉狭窄患者缺血症状,提高了支架置入的安全性和成功率,但长期疗效需要进一步观察。

OBJECTIVE： To study the safety and efficacy of Neuroform self-expanding stent for symptomatic intracranial artery stenosis. METHODS： A total of 37 patients with symptomatic intracranial artery stenosis received treatment at the Department of Neurosurgery, Affiliated Hospital of Behua University and Xuanwu Hospital were selected, who were ineffective to anticoagulation and antiplatelet treatment, including 24 males and 13 females, aged from 49 to 72 years, mean aged 64 years. All patients were received Neuroform self-expanding stent following angiography. RESULTS： All patients underwent PTAS with mean preoperative stenosis were reduced from 84% to 24% after percutaneous transluminal angioplasty （PTAS）. The technically successful rate was 100%. All the patients were received a 6-22 month follow-up （average 13 months）. The average artery stents was retrieved by 50%-90% after stent deployment. There was no arterial dissection, acute occlusion of the target artery or symptomatic distal emboli. Within the follow-up period, 1 patient endured asymptomatical artery full occlusion. Two stents were implanted simultaneously in 3 patients, 1 of them suffered bilateral vertebral artery stenosis, and 2 had right vertebral arterial and basilar artery stenosis. One patient suffered acute in-stent thrombosis and recovered after thrombolytic therapy. No pathogenetic condition was aggravated in the follow-up. CONCLUSION： The application of Neuroform self-expanding stent can alleviate the ischemic symptoms of patients with vertebrobasilar stenosis and elevate the operative safety and effectiveness. However, further study is needed to evaluate the long-term therapeutic effect.