血管成形术治疗症状性颅内动脉粥样硬化性狭窄的临床疗效观察

Clinical effect observation of angioplasty for symptomatic intracranial atherosclerotic stenosis

目的探讨血管成形术治疗症状性颅内动脉粥样硬化性狭窄的临床疗效。方法纳入2010年9月—2013年6月南京卒中注册系统中经规范的内科治疗失败后,行血管成形术的症状性颅内动脉狭窄患者82例。其中9例行单纯球囊扩张术,73例行颅内支架置入术。发病至手术的中位时间为24.5 d。评估术后终点事件(术后≤30 d任何卒中、死亡及>30 d责任血管供血区缺血性卒中或原狭窄处因再狭窄需要再次治疗)发生情况。影像学随访(CTA或DSA)再狭窄的发生率。结果 (1)82例中,手术成功率为92.7%(76例)。78例(95.1%)接受随访,失访4例。中位随访时间为22.5个月(四分位数:9,29个月)。10例发生终点事件,7例为缺血性卒中,1例为脑出血,2例为无症状重度再狭窄再次置入支架的患者。3例终点事件发生于术后≤30 d(均发生于术后≤24 h)。Kaplan-Meier曲线显示,1、6、12、24个月累积终点事件发生率分别为3.7%、8.6%、11.0%、13.0%。(2)60例(73.2%)患者接受影像学(11例行CTA,49例行DSA)检查,其中17例(28.3%)发生再狭窄,症状性再狭窄的发生率为5.0%(3例),无症状的为23.3%(14例)。结论经综合评估、严格筛选后,血管成形术治疗内科治疗无效的症状性颅内动脉狭窄患者,安全性高,中、远期疗效满意。

Objective To investigate the clinical effect of angioplasty for symptomatic intracranial atherosclerotic stenosis. Methods Eighty-two patients with symptomatic intracranial atherosclerotic stenosis whom underwent angioplasty after the failure of standard medical therapy were enrolled from Nan- jing Stroke Registry Program from September 2010 to June 2013. Nine of them underwent routine balloon angioplasty alone and 73 underwent intracranial stenting. The median time from onset to surgery was 24. 5 days. The occurrence of endpoint events （ any stroke ≤ 30 d after procedure, death and ischemic stroke 〉 30 d in guilty vessels or original stenosis had restenosis and needed to be treated again） was assessed. The incidence of restenosis was followed up with imaging （CTA or DSA）. Results （1）In the 82 patients, the success rate of operation was 92. 7% （ n = 72 ）, and 78 （ 95.1% ） received follow-up, 4 were lost to follow-up. The median follow-up time was 22. 5 months （ range 9 to 29 months ） . Ten patients had an endpoint event, 7 of them were ischemic stroke, 1 was cerebral hemorrhage, and two were severeasymptomatic restenosis who underwent stenting again. The endpoint events of 3 patients occurred at day 30 after procedure （at ≤24 h after procedure）. Kaplan-Meier curves showed that the incidences of cumulative endpoint events at 1,6,12, and 24 months were 3.7 %o , 8.6% , 11%, and 13 % , respectively. （ 2 ） 60 patients （73.2%） received imaging examination （11 CTA and 49 DSA）. Restenosis occurred in 17 patients （28.3%）, among them the incidence of symptomatic restenosis was 5% （n = 3 ）, and asymptomatic restenosis was 23. 3% （n = 14）. Conclusion After a comprehensive assessment and a rigorous screening, the safety is high and the mid- and long-term efficacy are satisfactory in patients with symptomatic intraeranial arterial stenosis who are treated with angioplasty when their medical treatment is invalid.