改良的预扩张技术置入Wingspan支架治疗大脑中动脉狭窄

Treatment of symptomatic middle cerebral artery stenoses with modified predilation technique and Wingspan stents

目的探讨改良的预扩张技术置入Wingspan支架治疗大脑中动脉狭窄的可行性、有效性及安全性。方法 2007年4月至2010年7月Wingspan支架置入治疗经药治疗无效的大脑中动脉狭窄(>50%)患者48例(其中1例双侧大脑中动脉狭窄)。根据不同预扩张技术,将其分成两组:A组(标准预扩张技术)和B组(改良的预扩张技术)。比较两组治疗效果、术后并发症、复发卒中和再狭窄发生率,并对其风险因子进行多元回归分析。结果本组成功率98%(48/49),最初终止事件包括1例小卒中和2例短暂脑缺血发作。A组狭窄度由(77.11±10.09)%降至(27.50±6.91)%,B组由(72.56±10.46)%降至(8.20±5.41)%。43例患者术后随访5～26个月,平均(12.92±5.08);A组和B组再狭窄率分别是44.4%(8/18)和12.0%(3/25),两组差异显著(P<0.05)。多元回归分析示再狭窄与残留狭窄和糖尿病有关。结论 Wingspan支架治疗大脑中动脉狭窄成功率较高和手术并发症发生率较低,改良预扩张技术可降低残留狭窄程度和再狭窄率。

Objective To assess the safety and effectiveness of the treatment of the symptomatic middle cerebral artery （MCA） stenosis with modified predilation technique and Wingspan stents. Methods Of 48 patients with symptomatic MCA stenoses refractory to medical therapy, 19 （group 1） were received Boston guidelines predilation and 29 （group 2） the modified technique predilation before stenting. The curative effect, complications, recurrent symptoms and restenosis were assessed and the risk factors related to restenosis were analyzed by logistic regression. Results Successful stenting occurred in 48 of 49 lesions （98%）. The minor stroke occurred in 1 patient and transient ischemic attacks （TIA） in 2 patients during the periprocedural period. The extents of stenoses of MCA were decreased from （77.11± 10.09）% to （27.50±6.91）% in group 1 and from （72.56± 10.46）% to （8.20±5.41）% in group 2. Of 43 patients followed from 5 to 26 （mean, 12.92±5.08） months, 18 were in group 1 and 25 in group 2. The restenosis rate （44.4%, 8/18） was significantly higher in group 1 than that （12.0%, 3/25） in group 2 （P〈0.05）. Logistic regression analysis showed that the in-sent restenosis was significantly related to residual stenosis and diabetes （P〈0.05）. Conclusions Wingspan stenting for symptomatic MCA stenosis may be performed with high success and low complication rates, and the modified predilation with the Gateway balloon before the stenting may reduce the extent of residual stenosis and restenosis rate in the patients with symptomatic MCA stenosis.