Enterprise支架治疗复杂症状性颅内动脉粥样硬化性狭窄

Enterprise Stent in Treatment of Symptomatic Complex Intracranial Atherosclerotic Stenosis

目的评估Enterprise支架治疗复杂症状性颅内动脉粥样硬化性狭窄(intracranial atherosclerotic stenosis,ICAS)的安全性和有效性。方法收集2014年1月-2016年6月首都医科大学附属北京天坛医院介入神经病学科收治的24例复杂症状性ICAS[如路径迂曲,病变长(>15 mm),病变接近分叉,狭窄合并动脉瘤等]并经亚满意球囊扩张+Enterprise支架治疗的患者资料。主要终点事件定义为支架术后30 d内任何卒中(包括缺血性和出血性)、短暂性脑缺血发作(transient ischemic attack,TIA)或者死亡。次要终点事件为支架治疗成功;随访期间>50%的支架内再狭窄或者靶血管供血区的卒中或TIA。结果 24例入组患者中,主要终点事件发生率为4.2%(1/24),表现为无症状性蛛网膜下腔出血(subarachnoid hemorrhage,SAH),无缺血性并发症发生。支架治疗技术成功率为100%,血管狭窄率从(87.1±9.3)%降为(17.5±8.7)%。4枚狭窄附近动脉瘤同时栓塞。共18例患者进行了影像学随访,6例患者(33.3%)发生了支架内再狭窄。其中3例患者为症状性再狭窄并进行了支架内球囊扩张。结论亚满意球囊扩张+Enterprise支架置入治疗颅内复杂动脉粥样硬化性狭窄技术可行,具有较低并发症。经导管释放的支架可能提高支架治疗的安全性。

Objective To assess the feasibility and efficacy of Enterprise stent using in treatment of Symptomatic Complex Intracranial Atherosclerotic Stenosis （ICAS）. Methods The data of 24 patients with symptomatic severe stenosis of a major intracranial artery refractory to aggressive medical therapy were treated by undersized balloon angioplasty and Enterprise stent deployment from January 2014 to June 2016 were collected. All the lesions were considered as complex ICAS, i.e. with tortuous access, long （〉15 mm） lesions and/or arterial bifurcations, or with concurrent aneurysms near the stenotic lesion. The primary outcome was defined any stroke （including ischemic or hemorrhagic）, transient ischemic attack （TIA） or deaths after stenting procedure within 30 days. The secondary outcome was successful revascularization;occurrence of ＆gt;50% in-stent restenosis; or occurrence of TIA or stroke attributable to the target vessel during the follow-up. Results Of the 24 patients included, the 30-day stroke, TIA or death was 4.2% （1/24）, which presented as asymptomatic subarachnoid hemorrhage （SAH）. There was no ischemic complications occurred during or after procedures （0%） in this cohort. The procedural success rate of 100 %, and stenosis was reduced from （87.1±9.3）% to （17.5±8.7）%. Four concurrent aneurysms were embolized simultaneously. Eighteen patients underwent imaging follow-up and 6 patients （33.3%） developed in-stent restenosis （ISR） during 6-month angiographic follow-up. Among which, 3 patients had symptomatic restenosis and underwent in-stent ballon angioplasty. Conclusion In this study, undersized balloon angioplasty followed by Enterprise stent deployment appears technically feasibility with a relatively low rate of complications for the treatment of ICAS. Stent with catheter-delivery might promote the procedural safety.