基底动脉中段支架术后穿支动脉闭塞的相关研究

Perforating artery occlusion occurring after stent implantation of middle segment of basilar artery: a clinical study

目的探讨基底动脉中段支架术后穿支动脉闭塞的影响因素,提供改善临床疗效的方法。方法回顾性分析26例应用Wingspan支架治疗症状性颅内基底动脉中段狭窄的疗效,观察其技术成功率、狭窄率的改变、围手术期并发症及术后症状改善情况。结果 26例患者共植入27枚Wingspan支架,技术成功率为100%。术后即刻血管造影证实,狭窄率由（78.8±7.5）%降为（23.1±7.4）%。2例患者出现围手术期并发症。按照Malek评分,分别评价术后24 h,术后1个月的预后情况：术后24 h评分,1分25例,4分1例;1个月后评分1分24例,4分1例,5分1例（术后2周死于肺部感染）;随访术后6～21个月,1分22例,3分1例,5分2例（1例患者术后7个月死于脑出血）,失访1例。结论应用Wingspan支架治疗症状性基底动脉中段狭窄对于穿支动脉的闭塞可以通过积极的措施预防及治疗,初步结果显示效果良好,但仍须大样本随机对照研究进行验证。

Objective To investigate the influence of stent implantation of middle basilar artery on the formation of perforating artery occlusion in order to provide effective means to improve clinical outcomes.Methods Wingspan stent implantation was carried out in 26 patients with symptomatic middle basilar artery stenosis. The technical success rate, the changes of arterial stenotic degree, the complications in perioperative period and the improvement of symptoms were determined, and the results were retrospectively analyzed.Results A total of 27 Wingspan stents were used in 26 patients, with a technical success rate of 100%.Angiography performed immediate after the stenting showed that the stenosis ratio decreased from preoperative（78.8 ± 7.5）% to postoperative（23.1 ± 7.4）%. During perioperative period, complications occurred in two patients, and perforating artery occlusion was clinically suspected in the two patients. According to Malek scoring, the prognosis at 24 hours and one month after the procedure was evaluated. The prognosis score within 24 hours was one point in 25 cases and 4 points in one case, who died from pulmonary infection two weeks after the operation. All patients were followed up for 6- 21 months, and the prognosis score was 1point in 22 cases, 3 points in one case, 5 points in 2 cases. One patient died of intracerebral hemorrhage 7months after the procedure. One case was lost in touch. Conclusion For symptomatic middle basilar artery stenosis, Wingspan stent implantation can effectively prevent perforating artery occlusion. Initial results indicate that this technique carries excellent and satisfactory clinical efficacy, although large randomized controlled studies are needed to further confirm the result.