Wingspan支架治疗颅内小血管症状性粥样硬化性狭窄的临床研究

Intracraniai angioplasty with wingspan stents for symptomatic atherosclerotic stenosis in small vessels： a study of long-term follow-up

目的 分析wingspan支架治疗颅内小血管（直径≤2.5 mm）硬化性狭窄的安全性及长期预后.方法 共有39例狭窄＞50%的症状性颅内小血管狭窄的患者接受了wingspan支架治疗.评估患者的临床表现、影像特点对手术安全性及随访结果的影响.结果 手术技术成功率为97.4%.1例患者术后出现了过度灌注损伤,其余患者术后没有出现严重并发症.24例患者进行了数字减影血管造影（DSA）或磁共振血管造影（MRA）随访,8例患者出现了支架内再狭窄（ISR）,其中3例为症状性再狭窄（33.3%）.血管长度＞15.3 mm的病变ISR的发生率高于血管长度＜15.3 mm的病变（67%,13%）.参照血管直径/支架直径比值＜0.78的病变ISR的发生率高于比值＞0.78的病变（60%,14%）.结论 血管成形及支架植入术治疗颅内小血管症状性粥样硬化性狭窄是安全的.虽然其ISR的发生率较高,但多无相关临床症状.

Objective To evaluate the safety and long-term prognosis of endovascular revascularization for intracranial atherosclerotic stenosis with Wingspan stent in small vessels. Methods A total of 39 patients received treatments with wingspan stents. All had neurological symptoms attributable to intracranial stenoses （≥50%）. The investigators evaluated the effect of clinical manifestations and imaging features on the safety and long-term results. Results Among all patients, 38 were successfully stented during a treatment session. Only one had postprocedural hyperperfusion injury. And 24 patients underwent digital subtraction angiography or magnetic resonance angiography follow-up. Among them, 8 patients were of in-stent restenosis （ISR）. And 3 had clinical symptoms. The average length of vascular lesions was 15.3mm. And the patients whose length of vascular lesions was above 15.3mm had much higher rates of ISR （67% vs 13%）. The average ratio of reference vessel diameter to stent diameter was 0.78. And the patients whose ratio was less than 0.78 had much higher rates of ISR （60% vs 14%）. Conclusion Intracranial angioplasty with wingspan stents may be performed to treat small intracranial vessels with a relatively high degree of safety. The rate of ISR is relatively high and a majority of patients stay asymptomatic.