Enterprise支架在治疗颅内后循环动脉粥样硬化性狭窄中的应用价值

Application value of enterprise stent on posterior circulation intracranial atherosclerotic stenosis

目的:探讨Enterprise支架治疗颅内后循环动脉粥样硬化性狭窄(ICAS)的安全性及有效性。方法:回顾性研究。纳入2017年6月—2020年4月在哈尔滨医科大学附属第一医院神经外科接受Enterprise支架置入治疗的后循环ICAS患者57例(58处狭窄病变),其中男37例(64.91%)、女20例(35.09%),年龄41~71(61.57±8.36)岁。病变位于基底动脉43处(74.14%),位于椎动脉颅内段15处(25.86%)。患者术前狭窄率为87.69%±7.62%,改良Rankin量表(mRS)评分均≤2分,美国国立卫生研究院卒中量表(NIHSS)评分>3分1例(1.75%)、≤3分56例(98.25%)。观察患者围手术期并发症,术后出院时mRS、NIHSS评分,随访期间与责任血管区域相关的短暂性脑缺血发作、缺血性卒中等血管事件,以及支架内再狭窄与症状性再狭窄发生情况。结果:手术技术成功率100%,围手术期并发缺血性卒中3例(5.26%)、出血性卒中1例(1.75%),术后出院时mRS评分0~2分56例、3分1例,NIHSS评分>3分1例、≤3分56例。43例患者接受电话或门诊随访,随访时间5~33(17.74±9.47)个月。31例(72.10%)患者31处病变接受影像学随访,随访时间5~21(14.12±4.08)个月。随访期发生与病变血管供血区一致的缺血事件3例(6.98%),其中1例(2.33%)缺血性卒中、2例(4.65%)短暂性脑缺血发作;支架内再狭窄4例(12.90%),症状性再狭窄2例(6.45%)。结论:Enterprise支架治疗后循环ICAS具有一定程度的安全性和有效性,不过仍然需要更多的前瞻性研究证实。

Objective This study aimed to explore the safety and effectiveness of Enterprise stent as a treatment of posterior circulation intracranial atherosclerotic stenosis(ICAS).Methods A retrospective analysis was conducted on 57 patients with posterior circulation ICAS(58 lesions)who received Enterprise stent implantation in the Department of Neurosurgery of the First Affiliated Hospital of Harbin Medical University from June 2017 to April 2020.These patients consisted of 37 males(64.91%)and 20 females(35.09%),aged 41-71(61.57±8.36)years.The lesion was located in 43 places(74.14%)of the basilar artery and 15 places(25.86%)in the intracranial segment of the vertebral artery.The preoperative stenosis rate was 87.69%±7.62%.The modified Rankin scale(mRS)scores of all patients before the operation were≤2 points,and the National Institutes of Health stroke scale(NIHSS)scores were>3 points in 1 case(1.75%)and≤3 points in 56 cases(98.25%).Perioperative complications,mRS and NIHSS scores at discharge after surgery,and vascular events such as transient ischemic attack and ischemic stroke related to the responsible vascular area were observed during follow-up.The occurrence of in-stent restenosis and symptomatic restenosis was also noted.Results The success rate of surgical technique was 100%.Three cases(5.26%)were complicated with ischemic stroke during perioperative period,1 case(1.75%)with hemorrhagic stroke,56 cases were discharged with mRS of 0-2 scores,and 1 case was 3 scores.NIHSS score was>3 points in 1 case and≤3 points in 56 cases.Forty-three patients were followed up by telephone or outpatient for 5-33(17.74±9.47)months.Thirty-one(72.10%)patients with 31 lesions received imaging follow-up for 5-21(14.12±4.08)months.The following events occurred during follow-up:three cases(6.98%)of ischemic events consistent with the blood supply area of the diseased vessel,one case(2.33%)of ischemic stroke,two cases(4.65%)of transient ischemic attack,four cases(12.90%)of in-stent restenosis,and two cases(6.45%)of symptomatic restenosis.Conclusions The use of Enterprise stents to treat post-circulation ICAS has a certain degree of safety and effectiveness but still requires further prospective trials for confirmation.