93例单纯球囊扩张血管成形术与支架植入术在症状性颅内动脉粥样硬化性狭窄患者中的比较

Safety and efficacy of percutaneous transluminal angioplasty versus percutaneous transluminal angioplasty and stenting in patients with symptomatic intracranial atherosclerotic stenosis:An analysis of 93 cases

目的 比较单纯球囊扩张血管成形术(PTA)与支架植入血管成形术(PTAS)治疗不同临床特点的症状性颅内动脉粥样硬化性狭窄(sICSA)患者的安全性及有效性。方法 回顾性分析西南医科大学附属医院2018年9月—2022年5月共计93例手术病例,根据患者的血管形态及年龄将手术方式分为PTA组(56例)及PTAS组(37例)。比较两组患者的一般资料、手术成功率、术后30 d内严重并发症发生率、术后3月MRS评分、术后6月mRS评分及术后1年责任血管再次卒中率。结果 在病变血管MORI分型C患者PTA组多于PTAS组;两组的其余基线特征无明显差异。PTA组与PTAS组的手术成功率(98.2%vs 100%),术后30 d内严重并发症发生率(3.6%vs 2.7%)以及术后3月的良好预后率(92.7%vs 94.1%)、术后6月的良好预后率(94.5%vs 94.1%)、术后1年内手术血管再次卒中率(3.6%vs 2.9%)均无明显差异。结论 在病变血管MORI分型C中,PTA安全性明显高于PTAS;其余患者两组间在手术成功率、围手术期严重并发症发生率、术后效果及术后1年症状再狭窄率均无明显差异。

Objective To investigate the safety and efficacy of percutaneous transluminal angioplasty(PTA)ver-sus percutaneous transluminal angioplasty and stenting(PTAS)in the treatment of symptomatic intracranial atherosclerotic stenosis(sICSA)with different clinical features.Methods A retrospective analysis was performed for 93 surgical cases in The Affiliated Hospital of Southwest Medical University from September 2018 to May 2022,and according to the vascu-lar morphology,age,and surgical procedure of the patients,they were divided into PTA group with 56 patients and PTAS group with 37 patients.The two groups were compared in terms of general information,surgical success rate,the inci-dence rate of serious complications within 30 days after surgery,modified Rankin Scale(mRS)score at 3 and 6 months af-ter surgery,and the rate of recurrent stroke of responsible vessels at 1 year after surgery.Results In patients with MORI type C of diseased vessels,there were more patients in the PTA group than in the PTAS group.There were no significant dif-ferences in the remaining baseline characteristics between the two groups.There were no significant differences between the PTA group and the PTAS group in terms of the success rate of surgery(98.2%vs 100%),the incidence of serious com-plications within 30 days after surgery(3.6%vs 2.7%),the good prognosis rate at 3 months after surgery(92.7%vs 94.1%),the good prognosis rate at 6 months after surgery(94.5%vs 94.1%),and the rate of re-stroke within 1 year after surgery(3.6%vs 2.9%).Conclusion In the MORI classification C of diseased vessels,the safety of PTA was significantly higher than that of PTAS.There were no significant differences in the success rate of surgery,the incidence of serious periopera-tive complications,the postoperative effect and the rate of symptomatic restenosis at 1 year after surgery between the two groups.