支架成形术治疗颅内血管狭窄的安全性及短期疗效分析

Safety and short-term results of stent-assisted angioplasty for the treatment of intracranial arterial stenosis

目的 评价血管内支架成形术治疗颅内动脉狭窄的安全性及短期疗效。方法 对 4 6例患者 5 0处颅内动脉狭窄病变行血管内支架成形术 ,其中基底动脉狭窄 16处 ,椎动脉颅内段狭窄12处 ,颈内动脉颅内段狭窄 13处 ,大脑中动脉狭窄 9处。结果 5 0处狭窄中有 4 9处成功地进行了支架成形术 (98% ) ,动脉狭窄程度从治疗前的 (72 4± 12 3) %降为 (10 6± 7 8) %。本组患者无手术死亡及缺血性脑卒中 ;4例出现和操作有关的并发症 ,其中 1例发生近端颅外段颈内动脉夹层 ,1例微导丝引起颅内出血 ,2例穿刺部位出现皮下血肿。 37例患者临床随访超过 6个月 (平均 8 5个月 ) ,无缺血性脑卒中发生。结论 血管内支架成形术治疗颅内动脉狭窄的成功率高 ,具有一定的安全性 。

Objective To evaluate the safety and short term outcome of endovascular stent assisted angioplasty for the treatment of intracranial arterial stenosis. Methods Angioplasty and stent placement were administered to treat 46 patients with lesions of atherosclerotic intracranial stenosis, including 16 lesions of basilar artery, 12 of vertebral artery, 13 of internal carotid artery and 9 of middle cerebral artery. Results Technical success was achieved in 49 of 50 vessels (98%), with no procedure related death or cerebral ischemic attack. Extracranial internal carotid artery dissection occurred in 1 patient and was successfully treated with a self expand stent. One patient had subarachnoid hemorrhage because of perforation by microwire with no permanent neurologic deficit, and another 2 patients had groin hematoma. Angiographic examination immediately after stenting revealed that the stenosis rate was significantly reduced (72 4%±12 3% vs 10 6%±7 8%). There was no cerebral ischemic attack in the 37 patients who were clinically followed up (6～18 months, mean of 8 5 months). Conclusion Angioplasty and stenting for the treatment of intracranial stenosis is safe and feasible, and it may be favorable for decreasing the incidence of ischemic attack.