颅内动脉支架术后栓子脱落发生率的临床研究

Embolic shedding after intracranial stenting: a clinical study

目的分析弥散加权成像(DWI)在颅内动脉粥样硬化性狭窄支架成形术前后的变化,研究支架术后颅内新发缺血梗塞灶的发生率、分布、危险因素和临床意义。方法对61例颅内动脉粥样硬化性狭窄患者行支架成形术并在术前7 d内和术后3 d内行DWI检查,分析支架手术前后DWI的变化,对术后新发缺血梗塞灶的发生率、分布、危险因素及其与发生症状性缺血并发症之间的关联进行回顾性地分析。结果支架术后有新发缺血梗塞灶23例,发生率为37.7%,其中出现新发无症状缺血梗塞灶20例,症状性缺血并发症3例;术前发病症状为短暂性脑缺血发作(TIA)、狭窄位于大脑中动脉、术中行球囊后扩是支架术后发生新发缺血梗塞灶的危险因素(P<0.05);在术后新发缺血梗塞灶的数量和大小方面,20例无症状新发缺血梗塞灶患者与3例症状性缺血并发症患者并无明显差别(P>0.05),但3例症状性缺血并发症患者均发生了狭窄相关的穿支梗塞。结论颅内动脉粥样硬化性狭窄支架成形术后颅内新发缺血梗塞灶的发生率较高,对相关危险因素的控制可能会降低其发生率。

Objective The aim of this study is to investigate the incidence of the new Diffusion- weighted Imaging （ DWI ） lesions and the possible risk factors, distribution, clinical implications for the lesions after intracranial stenting. Methods A total of 61 patients with symptomatic intracranial atherosclerotic stenosis underwent both stenting and post-stenting DWI. The incidence, distribution, risk factors and its relationship with symptomatic ischemic complications （SIC） were evaluated retrospectively. Results A total of 23 （37.7%） patients had new DWI lesions and SIC occurred in 3 patients. Transient isehemic attack （TIA） , middle cerebral artery and post-balloon were the risk factors （ P 〈 0.05 ）. There was no difference between the asymptomatic patients and SIC in the number or the size of the DWI lesions （ P 〉 0.05）. However, SIC occurred more frequently in the stenosis-associated perforator infarction. Conclusion The incidence of new DWI lesions after intracranial stenting for intracranial atherosclerotic stenosis is higher than we expected. And it may reduce its incidence by controlling the risk factors.