经皮血管内治疗症状性颅内脑动脉狭窄

Endovascular therapy for symptomatic intracranial artery stenosis

目的 研究对症状性颅内脑动脉狭窄进行血管内治疗的可行性和安全性。方法 19例症状性颅内脑动脉狭窄患者接受了内支架成形术或球囊成形术治疗。结果 本组MoriA型病变 12例 ,B组病变 5例 ,C型病变 2例 ;狭窄位于大脑中动脉 11例、大脑前动脉 1例、颅内颈内动脉 1例、颅内椎基底动脉 6例。在球囊成形术 (3例 )和内支架成形术 (16例 )后 ,平均动脉狭窄率从 82 .9%下降到8.0 % (P <0 .0 1)。在围手术期内 ,除 1例 (左大脑中动脉MoriC型病变 )发生蛛网膜下腔出血、死亡外 ,余无严重并发症发生。存活的 18例平均随访 3.7个月 (1～ 9个月 ) ,未发生缺血性神经事件。结论 内支架成形术或球囊成形术是治疗症状性颅内脑动脉狭窄有效的方法 ,但安全性尚需进一步研究 ,C型病变应当视为禁忌证。

Objective To study the safety and efficacy of endovascular therapy in the treatment of symptomatic intracranial artery stenosis. Methods The transluminal stent assisted angioplasty ( n =16) or angioplasty ( n =3) was performed in 19 patients with symptomatic intracranial artery stenosis. Results In all patients, Mori type A, B and C lesions were detected in 12, 5 and 2 cases respectively, and the stenotic sites in MCA, ACA, intracanial ICA and intracranial VBA were found in 11, 1, 1 and six respectively. After successful endovascular therapy, the degree of stenosis was significantly improved from 82.9% to 8.0% ( P <0.01). There were no serious complications during the periprocedural period, except one who had Mori type C stenosis of left middle cerebral artery trunk and got complication in SHA 2 hours after successful stent assisted angioplasty and died 36 hours later. Within mean follow up of 3.7 months (ranged from 1 month to 9 months), there were no episodes of ischemic neurological events in 18 survivors. Conclusions Endovascular therapy is effective and feasible for the treatment of symptomatic intracranial artery stenosis. Mori type C lesion should be considered as the contraindication of angioplasty. Larger number of studies are still warranted.