血管内成形术和支架植入术治疗症状性颅内动脉狭窄  

Percutaneous transluminal angioplasty and stenting for symptomatic intracranial atherosclerotic stenosis

作　　者：田会铭[1] 佟小光[1] 康伟民[1] 尚彦国[1] 水涛[1] 

机构地区：[1]天津市环湖医院神经外科,300060

出　　处：《中国现代神经疾病杂志》2010年第5期557-562,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的评价经皮血管内成形术和支架植入术治疗症状性颅内动脉狭窄的安全性、有效性和中短期疗效。方法 24例颅内动脉狭窄患者行经皮血管内成形术和支架植入术,其中颈内动脉颅内段狭窄6个,大脑中动脉狭窄7个,基底动脉及椎动脉颅内段狭窄11个。20例植入Wingspan支架,2例因Gateway球囊扩张满意而未植入支架,2例椎动脉颅内段狭窄者分别植入Apollo及Invastent Volo球囊支架。结果经皮血管内成形术和支架植入术后,患者血管狭窄率由手术前60%～95%降为手术后残余狭窄率0～20%。23例随访2～24个月,效果良好,未见复发。2例植入Wingspan支架后1～3 h出现脑出血,1例死亡,1例轻度偏瘫,死残率为8.33%。结论经皮血管内成形术和支架植入术治疗症状性颅内动脉狭窄有效,中短期疗效满意。在严格的准入标准下,Gateway球囊-Wingspan支架植入围手术期仍有严重并发症出现,值得关注。Objective To evaluate the safety, efficacy, and short- and medium-term effect of percutaneous transluminal angioplasty and stenting （PTAS） for symptomatic intracranial atherosclerotic stenosis. Methods Twenty-four patients with intracranial artery stenosis were treated by PTAS. Six lesions were detected at intracranial segment of internal carotid artery （ICA）, 7 at middle cerebral artery （MCA）, and 11 at intracranial segment of vertebrobasilar artery. Among them/22 Wingspan stents were implanted. Two cases were successfully treated by Gateway balloon without stenting. Two cases with vertebrobasilar artery stenosis were implanted with Apollo and Invastent Volo balloon stents, respectively. Results After treatment the stenosis rate in 24 patients was reduced from 60%-95% to 0-20%. The follow-up period of 23 patients was 2-24 months. The efficancy was satisfactory, and no recurrent was seen. There were 2 patients occurred cerebral hemorrhage after implanted Wingspan Stents 1-3 h later, one patient died and one patient presented hemiparalysis. The mortality and disability rate was 8.33%. Conclusion Percutaneous transluminal angioplasty and stenting for symptomatic inracranial artery stenosis is effective. The shortand medium-term effect is good. Although having strict entry-standards, Gateway balloon-Wingspan stent system still emerge serious complications, which should be paid with close attention.

关 键 词：颅内动脉疾病 动脉闭塞性疾病 血管成形术 支架 脑血管造影术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]