血管内支架成形术治疗症状性大脑中动脉狭窄

Endovascular stenting for symptomatic stenosis of middle cerebral artery

目的 总结血管内支架成形术治疗症状性大脑中动脉狭窄的疗效和初步经验。方法 对2 0例药物治疗无效的、反复短暂性缺血发作 (TIA)或有明显脑缺血症状的大脑中动脉狭窄患者行血管内支架成形术。术后常规给予抗血小板治疗 ,血管造影及TCD、SPECT进行影像学随访。结果 狭窄的血管均成功地进行扩张 ,术前术后狭窄程度分别为 (78.3± 4 .7) %与 (15 .6± 4 .4 ) % ,术后残余狭窄程度均小于 3 0 %。临床随访无TIA或脑梗死再发 ,DSA随访无血管再狭窄发生 ,经颅多普勒超声 (TCD)、SPECT检查显示脑血流明显改善。 1例发生大脑中动脉破裂出血。结论 血管内支架成形术治疗大脑中动脉狭窄是安全、有效的 ;

Objective To summarize the early experience and results of endovascular stenting for symptomatic stenosis of middle cerebral artery. Methods We performed percutaneous endovascular stent assisted angioplasty in 20 patients with symptomatic high grade stenosis of MCA, who had either recurrent transient ischemic attacks (TIAs) resistant to medical therapy or perfusion problems. After stenting, the patients was administrated with antiplatelet drug and followed up with DSA、TCD and SPECT. Results Stent placement and angioplasty were successfully performed in all patients except one with MCA rupture during the procedure. The mean degree of stenosis reduced from (78.3±4.7)% to (15.6±4.4)%, and the degree of residual stenosis were less than 30%. None of these patients developed TIAs or stroke during the follow up period. Angiography revealed no evidence of restenosis. TCD and SPECT suggested significant improvement of cerebral perfusion. Conclusions Endovascular stenting for MCA stenosis seems to be a safe and effective therapeutic method. Further study is needed for long term outcome.