支架技术在急性缺血性卒中合并颅内外动脉狭窄中的应用

Application of the stenting technology in the acute ischemic stroke with extracranial or intracranial arterial stenosis

目的探讨支架技术在急性缺血性卒中合并颅内外动脉狭窄中应用的可行性、安全性及有效性。方法回顾性纳入2014年4月至2016年10月在山东大学附属济南市中心医院神经外科就诊的29例急性缺血性卒中合并颅内外动脉狭窄的患者。经数字减影血管造影（DSA）证实责任动脉闭塞，患者取栓后仍有重度狭窄，遂行球囊扩张、支架置入血管成形术。记录患者治疗前、后7d美国国立卫生研究院卒中量表（NIHSS）评分、30d卒中或短暂性脑缺血性发作的复发率及90d改良Rankin量表评分（mRS）。临床随访分别在术后30d和90d进行。结果29例患者的技术成功率为100％，支架治疗后平均残留狭窄率为（10．4±8．1）％。所有患者均得到随访，30d内再次卒中1例。NIHSS评分：治疗前为（19．5±3．5）分，治疗后7d为（5．8±2．1）分，治疗前后的差异有统计学意义（P〈0．05）。90d患者的病死率为0％，其中28例（97％）90dmRS评分≤2分，预后良好。结论急性缺血性卒中合并颅内动脉狭窄患者应用支架技术的并发症发生率较低且安全、有效；但残余狭窄以及合并基础性疾病、医嘱依从性差被认为是卒中再发的危险因素。

Objective To explore the feasibility, safety and effectiveness of the stenting treatment for acute ischemie stroke （AIS） with extracranial or intracranial arterial stenosis. Methods A retrospective study was conducted about 29 consecutive patients who underwent stenting operation at Department of Neurosurgery, Jinan Central Hospital Affiliated to Shandong University between April 2014 and October 2016. All patients were diagnosed as AIS. Occlusion or stenosis of related arteries was determined by digital subtraction angiography （DSA）, and severe stenosis remained after stent thrombectomy. The NIHSS （National Institute of Health Stroke Scale ） scores were documented pre- and postoperatively, and recurrence rates of stroke and transient ischemic attack （TIA） within 30 days and mRS （modified Rankin scale ） outcome of 90 days were studied. Results The technical success rate was 100%. The mean rate of post-stenting residual stenosis was （ 10.4±8.1 ） %. The mean follow-up period was 3 months, and all patients were followed up. One patient had stroke within 30 days. The mean NIHSS scores were 19.5±3.5 （preoperatively） and 5.8±2. 1 （postoperatively）, which had significant difference （P 〈 0.05）. At 90-day follow-up, the mortality rate was 0% and 28 cases （97%） reported the mRS of no more than 2 which suggested good outcomes. Conclusions The complication rate of stenting in patients with AIS and cerebral arterial stenosis seems low. However, residual stenosis, comorbidity with underlying diseases and poor compliance with medical administrations were considered as risk factors for recurrence of stroke.