血管内支架置入术与强化药物治疗对症状性颅内动脉狭窄患者远期预后影响的对比研究

Comparative Study for Impact on Long-term Prognosis in Patients with Symptomatic Intracranial Artery Stenosis between Endovascular Stent Implantation and Intensive Drug Therapy

目的比较血管内支架置入术与强化药物治疗对症状性颅内动脉狭窄患者远期预后的影响。方法选取沧州市中心医院2012年6月—2013年6月收治的症状性颅内动脉狭窄患者88例,根据治疗方法分为对照组40例和观察组48例。对照组患者采用强化药物治疗,而观察组患者行血管内支架置入术。记录观察组患者血管内支架置入情况;比较两组患者治疗前及治疗后1年血管狭窄率和美国国立卫生研究院卒中量表(NIHSS)评分,随访6个月、6个月~1年及1~2年缺血性事件发生情况;观察两组患者治疗期间不良反应/并发症发生情况。结果观察组患者颅内动脉狭窄51处,血管内支架置入成功率为94.1%(48/51)。治疗前两组患者血管狭窄率和NIHSS评分比较,差异无统计学意义(P>0.05);治疗后1年观察组患者血管狭窄率低于对照组(P<0.05),而两组患者NIHSS评分比较,差异无统计学意义(P>0.05)。随访6个月、6个月~1年及1~2年观察组患者缺血性事件发生率均低于对照组(P<0.05);两组患者治疗期间不良反应/并发症发生率比较,差异无统计学意义(P>0.05)。结论与强化药物治疗相比,血管内支架置入术能更有效地改善症状性颅内动脉狭窄患者远期预后,且安全性较高。

Objective To compare the impact on long-term prognosis in patients with symptomatic intracranial artery stenosis between endovascular stent implantation and intensive drug therapy. Methods A total of 88 patients with symptomatic intracranial artery stenosis were selected in the Central Hospital of Cangzhou from June 2012 to June 2013,and they were divided into control group（ n = 40） and observation group（ n = 48） according to therapeutic methods. Patients of control group received intensive drug therapy, while patients of observation group received endovascular stent implantation. Endovascular stent implantation results of control group was recorded; vascular stenosis rate and NIHSS score before treatment and after 1 year of treatment,incidence of ischemic events within 6 months of follow-up,6 months to 1-year of follow-up,1-to 2-year follow-up were compared between the two groups; incidence of adverse reactions/complications was observed during the treatment. Results A total of 51 stenotic sites were found,and the success rate of endovascular stent implantation was 94. 1%（ 48/51）. No statistically significant differences of vascular stenosis rate or NIHSS score was found between the two groups before treatment（ P 0. 05）; after 1 year of treatmet,vascular stenosis rate of observation group was statistically significantly lower than that of control group（ P 0. 05）,while no statistically significant differences of NIHSS score was found between the two groups（ P 0. 05）. Within 6 months of follow-up,6 months to 1-year of follow-up,1- to 2-year follow-up,incidence of ischemic events of observation group was statistically significantly lower than that of control group,respectively（ P 0. 05）; no statistically significant differences of incidence of adverse reactions/complications was found between the two groups during the treatment（ P 0. 05）. Conclusion Compared with intensive drug therapy, endovascular stent implantation can more effectively improve the long-term prognosis in patients with symptomatic intracranial artery stenosis,with higher safety.