Gateway球囊与冠状动脉支架血管成形术的对比研究

Gateway balloon angioplasty and coronary stent angioplasty for intracranial atherosclerotic stenosis:a comparison study

目的评价Gateway球囊血管成形术治疗颅内动脉狭窄的有效性和安全性。方法 2007年6月至2012年12月收治22例(24处)颅内动脉狭窄患者,按Mori分型,A型10处,B型9处,C型5处。病变分别位于大脑中动脉6处、颈内动脉颅内段12处、椎动脉颅内段4处、基底动脉2处。根据全脑数字减影血管造影(DSA)检查分为Gateway球囊组12例和冠状动脉(冠脉)球囊扩张支架组(冠脉支架组)10例,比较两组手术成功率、术后动脉狭窄改善率及并发症发生率,并随访半年,复查DSA。结果Gateway球囊组与冠脉支架组手术成功率分别为100%(12/12)和90%(9/10),术后动脉狭窄改善率均>70%,并发症发生率分别为8.3%和10%,组间差异无统计学意义(P>0.05)。Gateway球囊组手术时间为75 min,冠脉支架组为95 min,组间差异有统计学意义(P<0.05)。冠脉支架组中1例术后13个月发生出血性脑卒中1次,经治疗好转。术后患者复查经颅多普勒超声,冠脉支架组1例、Gateway球囊组2例发生再狭窄,但均无临床症状。结论 Gateway球囊血管成形术可明显改善颅内动脉狭窄,降低脑血管事件的发生,安全有效。

Objective To evaluate the efficacy and safety of Gateway balloon angioplasty in treating intracranial artery stenosis. Methods During the period from June 2007 to Dec. 2012, a total of 22 patients with intracranial artery stenosis were admitted to the hospital. A total of 24 artery stenoses were detected in 22 patients. According to Mori classification, 10 lesions belonged to type A, 9 lesions belonged to type B and 5 lesions belonged to type C. The lesions were located at middle cerebral artery（n = 6）, intracranial segment of internal carotid artery（n = 12）, intracranial segment of vertebral artery （n = 4） and basilar artery （n = 2）. Based on DSA whole cerebral angiography findings, the patients were divided into Gateway balloon angioplasty group （n = 12） and coronary stent group （n = 10）. The success rate, postoperative improvement rate of stenosis and the occurrence of complications were compared between the two groups. All patients were followed up for half a year and DSA examination was employed. Results The success rate of angioplasty in Gateway group and in coronary group was 100% and 90% respectively. The postoperative improvement rate of stenosis was 70% for both groups, and the occurrence of complications in Gateway group and in coronary group was 8.3% and 10% respectively, the difference between the two groups was of no statistical significance （P 〉 0.05）. The operation time for Gateway group and coronary group was 75 min and 95 min respectively, the difference between the two groups was statistically significant （P 〈 0.05）. One patient in coronary group developed hemorrhagic stroke at 13 months after the treatment, which was well improved after medication. Postoperative examination with Doppler ultrasono- graphy showed that restenosis occurred in one patient of coronary group and 2 patients of Gateway group, although all three patients were asymp- tomatic. Conclusion For the treatment of intracranial artery, stenosis, Gateway balloon angioplasty is safe and effective, it can remarkably inlprove the stenosis of intracranial arteries and reduce the incidence of brain vascular events.（J Intervent Radiol, 2013, 22： 797-800）