Wingspan支架治疗症状性大脑中动脉M1段重度狭窄的并发症分析

Peri-procedural complications of stenting with Gateway-Wingspan system for symptomatic middle cerebral artery high-grade stenosis

目的研究Wingspan支架治疗症状性大脑中动脉重度狭窄的并发症。发生原因及防治措施。方法回顾性分析2008年2月至2012年5月,河南省人民医院介入治疗中心应用Wingspan支架治疗的102例症状性大脑中动脉M1段重度狭窄患者的临床资料,观察术中及术后30 d内出现的不良事件,分析其发生的原因。将术者早期完成的40例定义为技术不成熟阶段,术者后期完成的62例定义为技术成熟阶段。结果围手术期8例出现了并发症,并发症发生率为7.8%(8/102)。技术不成熟阶段并发症发生率为12.5%(5/40),明显高于技术成熟阶段的4.8%(3/62);出血性并发症发生率为3.9%(4/102),缺血性并发症发生率为3.9%(4/102);8例中,l例导丝头刺破远端分支血管,1例支架近端刺破脉络膜前动脉,2例术后出血考虑为过度灌注、抢救无效死亡,3例穿支卒中,1例穿支短暂性脑缺血发作(TIA)。死亡2例(2.0%),重残1例,轻度残障3例,无神经系统功能缺损2例。结论 Wingspan支架治疗症状性大脑中动脉重度狭窄风险相对较高,但对于手术操作熟练、适应证把握严格的术者,Wingspan支架成形术是相对安全的。

Objective To retrospectively record the periprocedural complications of stenting with Gateway-Wingspan system for symptomatic middle cerebral artery high-grade stenosis,analyze the reason and discuss the prevention methods.Methods We reviewed the medical records of Wingspan stenting for 102 cases with symptomatic middle cerebral artery high-grade stenosis from February 2008 to May 2012 and recorded all the periprocedural adverse events.All of the complications were analyzed.The initial 40 cases completed by the operators were taken into the unskilled stage and the rest 62 cases were taken into the skilled stage.Results Eight complications were recorded and the rate was 7.8%（8 /102）.The rate of complications in the unskilled stage was 12.5%（5 /40） which was obviously higher than the complications rate 4.8%（3 /62） in the skilled stage.the rate of hemorrhage complications was 3.9%（4 /102） which was equal to the rate of ischemic complications.The complications consisted of 2 artery perforation,2 intracranial hemorrhage because of hyperperfusion injury,3 perforator stroke and 1 TIA.Of those complications,2 cases with intracranial hemorrhage were dead,1 case got serious disability as a sequel,3 cases had slight disability and the others had no permanent neurological deficits.Conclusions The treatment of symptomatic middle cerebral artery high-grade stenosis with Gateway-wingspan system was at a relatively high-risk.But if the procedures were operated by the skilled operator,the treatment was relatively safe.