颅内动脉狭窄患者血管成形术与支架置入术临床和血管造影结果比较：病例系列研究

Comparison of clinical and angiographic outcomes of angioplasty and stenting in patients with intracranial arterial stenosis： a case series study

目的比较球囊扩张血管成形术、球囊扩张支架置人术和自膨式支架置人术治疗颅内动脉狭窄性病变的临床效果和影像学结果。方法选择南京卒中注册系统中因颅内动脉狭窄而行球囊扩张血管成形术或支架置入术的患者，根据手术方式的不同分为球囊扩张支架置入组、自膨式支架置入组和球囊扩张血管成形术组，比较其手术成功率、围手术期并发症发生率以及显著残余狭窄发生率。收集术后1、3、6、12和24个月时定期门诊或住院随访的临床和血管造影资料，比较2年内缺血性卒中和（或）死亡发生率以及再狭窄发生率。采用多因素Cox风险比例分析缺血性卒中复发和（或）死亡以及再狭窄的危险因素。结果183例患者共192处狭窄性病变行球囊扩张血管成形术或支架置入术治疗，其中球囊扩张支架置入组92例，自膨式支架置入组42例，球囊扩张血管成形组49例，术前狭窄程度分别为（80．25-12．8）％、（76．3±11．9）％和（89．7±10．2）％（F=15．863，P=0．000），其他基线资料均无显著性差异。球囊扩张支架置入组、自膨式支架置人组和球囊扩张血管成形术成功率分别为96．7％、95．2％和91．8％（r=1．646，P=0．439），围手术期并发症发生率分别为6．5％、14．3％和10．2％（Fisher精确概率法P=0．334），缺血性卒中和（或）死亡发生率分别为9．2％、4．8％和13．0％（Fisher精确概率法P=0．458），均无显著性差异。影像学随访显示，球囊扩张血管成形组再狭窄发生率为48．5％，虽然高于球囊扩张支架置入组的27．7％和自膨式支架置入组的34．8％，但无显著性差异（x2=4．176，P：0．124）。多因素Cox比例风险分析显示，球囊扩张皿管成形是术后再狭窄的独立危险因素（风险比2．490，95％可信区间1．247～4．969，P=0．010）。结论与球囊扩张式支架置入相比，球囊扩张血管成形更易发生再狭窄，但其与术后缺血性卒中复发和（或）死亡风险无关。

Objective To compare the clinical efficacy and angiographic outcomes of balloon dilation angioplasty, balloon-expandable stent implantation and self-expanding stent implantation in the treatment of intracranial arterial stenosis. Methods The patients with intracranial arterial stenosis who met the indications of shrgical intervention treated with balloon dilatation angioplasty and stent placement were selected from Nanjing Stroke Registry Program. According to the different interventional procedures, the patients were divided into the balloon expandable stenting group, the self-expanding stents group and the balloon dilatation angioplasty group. The success rate of surgery, the perioperative complication rate and the significant residual stenosis rate were cmpared among the three groups. The clinical and angiographic assessments were performed through 1-, 3-, 6-, 12- and 24-month regular outpatient or inpatient follow-up after procedure. The incidences of ischemic strokeand/or death and restenosis within 2 years were compared. Multivariate Cox proportional hazards analysis was used to analyze the risk factors for recurrent ischemic stroke and/or death and restenosis. Results A total of 183 patients with 192 stenoses performed balloon dilatation angioplasty or stenting, in which 92 were in the balloon expandable stenting group, 42 were in the serf-expanding stents goup and 49 in the balloon dilatation angioplasty group, Their preoperative stenosis rates were 80. 2 ±12. 8% ,76. 3 ± 11. 9% and 89. 7± 10. 2%, respectively （F = 15. 863, P =0. 000）. There were no significant differences in other baseline data. The success rates of surgery in the balloon expandable stenting group, self-expanding stents group and balloon dilatation angioplasty group were 96. 7%, 95. 2% and 91.8%, respectively （x2 = 1. 646, P =0. 439）. The perioperative complication rates were 6. 5%, 14. 3% and 10. 2%, respectively （Fisher exact test, P =0. 334）. The imaging follow-up showed that the restenosis rate in the balloon dilatation angioplasty group was 48. 5%. Although it was high than 27. 7% in the balloon expandable stenting group and 34. 8% in the self-expanding stents group, there were no significant differences （X2 = 4. 176, P = 0. 124）. Multivariate Cox proportional hazards analysis showed that balloon dilatation angioplasty was an independent risk factor for restenosis after procedure （hazard ratio 2. 490, 95% confidence interval 1. 247 - 4. 969, P = 0. 010）. Conclusions Compared to the balloon expandable stenting, the balloon dilatation angioplasty is more likely to have restenosis, but it is not associated with the risks of postoperative recurrent iscliemic stroke and/or death.