支架成形术与单纯药物治疗症状性大脑中动脉重度狭窄的临床对比研究

Stenting versus drug therapy: comparative study of clinical outcomes in treatment of symptomatic middle cerebral artery stenosis

目的评价并比较症状性大脑中动脉狭窄支架成形术与单纯药物治疗的安全性及远期疗效。方法回顾性分析自2009年10月至2015年1月因症状性大脑中动脉严重粥样硬化狭窄(狭窄度超过70%)在我院接受治疗的146例患者的资料,根据患者治疗方案的不同分为支架组67例,药物组79例,患者的临床基线资料、术前术后影像学结果、围手术期并发症情况、临床随访期间不良事件发生情况、影像学复查情况被前瞻性记录并被回顾性分析。结果 1接受治疗后30 d内支架组4例(6.0%,4/67)发生卒中,包括2例(3.0%,2/67)致死致残性卒中,药物组3例(3.8%,3/79)出现缺血性卒中包括1例(1.3%,1/79)致残性卒中,支架组30 d内卒中及致死致残性卒中发生率略高于药物组,但无统计学差异(P>0.05)。2两组所有患者随访(20.8±9.2)个月,30 d后随访期间,支架组共4例(6.2%,4/65)发生治疗侧缺血性卒中,4例均为非致死致残性卒中;药物组共7例(9.0%,7/78)出现治疗侧缺血性卒中,6例(7.7%,6/78)为致残性卒中。两组随访期间总的卒中发生率无统计学差异(P>0.05),但支架组致死致残性卒中发生率明显低于药物组(P=0.032)。结论支架成形术治疗大脑中动脉狭窄的安全性较单纯药物治疗稍差,两种治疗手段对卒中预防的总体效果无明显差别,但支架成形术对远期致死致残性卒中的预防效果优于单纯药物治疗。

Objective To evaluate and compare the safety and long-term therapeutic efficacy of stenting versus drug therapy in the treatment of symptomatic middle cerebral artery stenosis. Methods A retrospective study of 146 patients with symptomatic middle cerebral artery atheroselerosis stenosis （ stenosis 〉 70% ） enrolled in the second affiliated hospital of Zhengzhou university from October 2009 to January 2015 was performed. The patients were divided to stenting group （n = 67 ） and drug group （n = 79 ）. The data, including patients＇ clinical baseline information, imaging of pre- and post-operation, perioperative complications, adverse events during clinical follow-up and outcomes of imaging follow-up, were recorded prospectively and analyzed retrospectively. Results （ 1 ） After 30 d of treatment, 4 patients （6.0%, 4/67 ） had stroke including 2 cases （3.0% , 2/67 ） of fatal or disabling stroke in the stenting group, whereas 3 patients （3.8%, 3/79） occurred ischemic stroke including 1 case （1.3%, 1/79） of disabling stroke in the drug group. The risk of stroke including fatal or disabling stroke in the stenting group was slightly higher than that in the drug group, but the difference was not significant （P 〉 0.05）. （2） The mean follow-up period for all patients was 20.8 ±9.2 months. After a follow-up of 30 d, 4 ipsilateral strokes （6.2%, 4/65） occurred in the stenting group, none of which were fatal or disabling strokes ; 7 ipsilateral strokes （9.0%, 7/78） were found in the drug group, which 6 patients （7.7% , 6/78） had disabling strokes. Although the incidence of stroke between the 2 groups was not significant （ P 〉 0.05 ）, the occurrence rate of disabling stroke in the stenting group was much lower than that in the drug group （P = 0. 032）. Gonclusion The safety of stenting is slightly worse than that of drug therapy in the treatment of symptomatic middle cerebral artery stenosis. The overall effect of the 2 therapeutic regimens on stroke prevention is not significantly different. However, stenting treatment is superior to drug therapy in a long-term prevention of recurrent fatal or disabling stroke.