亚满意球囊扩张联合Enterprise支架治疗复杂症状性颅内动脉粥样硬化性狭窄的临床疗效分析

Clinical analysis of submaximal balloon dilatation combined with Enterprise stent in treatment of complex symptomatic intracranial atherosclerotic stenosis

目的探讨亚满意球囊扩张联合Enterprise支架治疗复杂症状性颅内动脉粥样硬化性狭窄(ICAS)的安全性及有效性。方法选择河北医科大学第二医院神经内科自2015年2月至2018年9月采用亚满意球囊扩张联合Enterprise支架治疗的70例复杂症状性ICAS患者,观察术后30 d内围手术期脑血管病事件[包括脑梗死、短暂性脑缺血发作(TIA)及脑出血等]或死亡情况,以及30 d后随访期内病变血管供血区缺血事件复发或支架内再狭窄情况。结果70例患者中手术成功率为100%,颅内动脉狭窄率由术前的81.4%±10.2%降至术后的18.3%±6.4%,差异有统计学意义(P<0.05)。术后30 d内4例(5.7%)发生并发症,其中2例为术后2 d支架内亚急性血栓形成,1例为术后10 h脑出血,1例为穿支动脉闭塞致脑桥梗死。术后30 d后随访期内,9例(14.5%)发生支架内再狭窄,其中症状性再狭窄3例(4.8%)。结论亚满意球囊扩张联合Enterprise支架治疗复杂症状性ICAS安全有效,可明显降低术后并发症发生率及近期支架内再狭窄发生率。

ObjectiveTo observe the safety and efficacy of submaximal balloon dilation combined with Enterprise stent in the treatment of complex symptomatic intracranial atherosclerotic stenosis (ICAS). MethodsClinical data of 70 patients with complicated symptomatic ICAS treated in our hospital from February 2015 to September 2018 were retrospectively analyzed, and any stroke (cerebral infarction or transient ischemic attack [TIA] or cerebral hemorrhage), or death within 30 days were observed, as well as the recurrence of ischemic events and stent restenosis in the vascular supply area after 30 d of follow-up. ResultsAmong the 70 patients, the success rate of operation was 100%;the preoperative stenosis rate was (81.4±10.2)% and the postoperative stenosis rate was (18.3±6.4)%, with significant difference (P<0.05). Perioperative complications occurred in 4 patients (5.7%): two were subacute thrombosis in stent two d after operation;one had cerebral hemorrhage 10 h after operation, and one had perforator artery occlusion leading to pontine infarction. Nine patients (14.5%) had restenosis in stent during the follow-up period;symptomatic restenosis occurred in 3 (4.8%). ConclusionIt is safe and effective to treat complex symptomatic ICAS with submaximal balloon dilatation combined with Enterprise stent, which can obviously decrease the incidences of postoperative complications and recent in-stent restenosis.