血管内支架成形术治疗颅内动脉狭窄

Endovascular stent-assisted angioplasty for intracranial artery stenosis

目的分析血管内支架成形术治疗症状性颅内动脉狭窄的有效性及安全性。方法回顾性分析103例症状性颅内动脉狭窄病人的临床资料,共103处狭窄,其中基底动脉狭窄29处,椎动脉颅内段狭窄23处,颈内动脉颅内段狭窄3处,大脑中动脉狭窄48处。均行血管内支架成形术,并通过临床症状、改良Rankin量表评分评价其疗效。结果手术成功101例,植入支架101枚,平均动脉狭窄程度从术前的82.84%±8.14%降为术后的10.61%±5.09%;手术失败2例(支架无法到位1例,刺破动脉1例)。术后临床症状消失28例,好转51例,无明显变化19例,因并发症加重5例。67例DSA随访6～14个月,出现再狭窄27例,其中再狭窄率<50%21例,再狭窄率≥50%6例。临床随访12个月,新发TIA 4例,小面积脑梗死4例,少量脑室出血1例。结论血管内支架成形术是治疗症状性颅内动脉粥样硬化性狭窄的安全、有效手段。

Objective To analyze the efficacy and safety of endovascular stent-assisted angioplasty(ESA) in the treatment of symptomatic intracranial artery stenosis. Methods Clinical data of 103 patients with symptomatic intracranial arterial stenosis were analyzed retrospectively and a total of 103 stenoses were treated with ESA. Moreover, the stenosis was located in the basilar artery in 29, in intracranial branch of the vertebral artery in 23, in intracranial branch of the internal carotid artery in 3, and in middle cerebral artery in 48. The efficacy was evaluated by clinical symptoms and modified Rankin scale. Results ESA was successful in 101 patients, and 101 stents were implanted. The mean stenosis rate was reduced from 82.84% ± 8.14% preoperatively to 10.61% ± 5.09% postoperatively. The operation failed in 2 patients(1 stent was out of the place and 1 artery pierced). The postoperative clinical symptoms disappeared in 28 patients, improved in 51, had no obvious change in 19 and aggravated by complications in 5. Sixty-seven patients were followed up from 6 to 14 months, the restenoses occurred in 27 patients, the restenosis rate was less than 50% in 21 and more than 50% in 6. During a clinical follow-up period of 12 months, the new transient ischemic attack occurred in 4 patients, small area cerebral infarctions and a little ventricular hemorrhage was seen in 1 respectively. Conclusion ESA is a safe and effective method in the treatment of symptomatic intracranial atherosclerotic stenosis.