支架成形术及药物治疗症状性大脑中动脉狭窄的随机对照研究

Stent implantation combined with drug therapy versus pure drug therapy for symptomatic severe stenosis of middle cerebral artery: a randomized and comparative study

目的比较单纯药物治疗及药物联合支架治疗症状性大脑中动脉重度狭窄的疗效。方法采用单中心、随机、对照、前瞻性研究,将34例症状性大脑中动脉狭窄≥70%的患者随机分为药物治疗组(药物组)18例和药物联合支架治疗组(支架组)16例,并进行12个月以上的随访,终点事件为狭窄动脉供血区出现脑卒中。结果支架组与药物组均无出血性脑卒中发生。随访期内,药物组18例中发生狭窄侧大脑中动脉供血区再发脑梗死5例(27.78%),3例发生大脑中动脉闭塞(16.67%,其中2例为无症状性闭塞),支架组未发生支架侧脑梗死,12个月时复查DSA无支架内再狭窄或闭塞。支架组缺血性脑卒中复发率低于药物组(P<0.05)。结论选择性的支架治疗对预防缺血性脑卒中的复发可能较单纯药物治疗更为有效。

Objective To compare the clinical efficacy of stent implantation combined with drug therapy and pure drug therapy in treating symptomatic severe stenosis of middle cerebral artery. Methods As a singlecenter, randomized, comparative and prospective study, a total of 34 patients with symptomatic severe stenosis of middle cerebral artery （ ≥ 70%） were collected. The patients were randomly divided into pure drug therapy group （n = 18） and stent group （stent implantation together with drug therapy, n = 16）. All the patients were followed up for at least 12 months. The end-point event was the occurrence of cerebral stroke at the cerebral region that was supplied by the narrowed artery. The clinical results were analyzed and were compared between the two groups. Results No hemorrhagic stroke occurred in both groups. During the follow-up period, in the pure drug therapy group recurrent cerebral infarction at the area that was supplied by middle cerebral artery at the diseased side occurred in five cases （27.78%）, and the occlusion of middle cerebral artery was seen in three cases （16.67%）, two of whom showed no clinical symptoms of cerebral artery occlusion. No cerebral infarction occurred in the stent group. DSA performed 12 months after the treatment showed no instent stenosis or occlusion. Conclusion Selective stent implantation therapy is probably more effective than pure drug therapy for the protection from the recurrence of ischemic stroke. （J Intervent Radiol, 2013, 22： 089-092）