血管内支架置入术治疗症状性颅内动脉狭窄的临床研究

Clinical analysis on intravascular stenting for symptomatic intracranial arterial stenosis

目的探讨颅内动脉支架置入术治疗症状性颅内动脉狭窄的有效性,安全性,以及近期临床疗效及围手术期并发症的防治。方法对入选的68例颅内动脉狭窄的患者,于颈内动脉颅内段、大脑中动脉、椎动脉颅内段及基底动脉狭窄处行支架置入治疗,手术前后对患者行经颅脑多普勒超声(TCD)检查,评估颅内血流动力学情况;临床症状体征变化采用美国国立卫生研究院卒中量表评分(NIHSS);血管狭窄采用华法令-阿司匹林症状性颅内动脉病变(WASID)标准计算术前术后狭窄率;对术后所有病例进行短期(3～6个月)随访。结果 68例患者共置入73枚支架,手术成功率为95.59%,其中3例因颅内血管过度迂曲,支架未能达到狭窄部位,余支架置入均一次成功,支架位置准确,膨胀良好,血流通畅。1例术中出现血管痉挛,2例出现新发颅内缺血事件,2例出现颅内出血,余患者均反应良好。结论血管内支架置入术治疗颅内动脉狭窄安全性高、创伤性小,近期疗效明显,远期疗效有待进一步研究。

Objective To explore the efficacy,safety,recent clinical curative effect,and the prevention of perioperative complication of intravascular stent for symptomatic intracranial arterial stenosis.Methods In 68 patients with intracranial artery stenosis,stent treatment was done in intracranial section of internal carotid artery,the middle cerebral artery,intracranial section of vertebral artery and basal artery.CT scan was performed to assess intracranial situation,while NIHSS score for clinical symptoms and signs and NASCET standard for vascular stenosis calculation in perioperative stage.All cases were followed up for a short time of 3 to 6 months.Results In 68 patients,73 stents were placed,and operation achievement ratio was 95.59%,of which 3 cases failed to achieve the destination due to the excessive blood vessels.The rest were placed successfully and postoperative imaging showed accurate stents position,good stent inflation and distal vascular blood flow.New onset of ischemic events were found in two cases,1 with angiospasm,and two with intracranial hemorrhage,while the rest responded well after surgery.Conclusions Intravascular stenting with less trauma and obvious efficacy is safe for symptomatic intracranial arterial stenosis.The long-term outcome needs further exploration.