Wingspan支架治疗症状性颅内动脉狭窄的疗效及随访  

Treatment of symptomatic intracranial arterial stenosis with Wingspan stent system

作　　者：罗望池[1] 李贵福[1] 李铁林[1] 朱吉祥[1] 尤劲松[1] 马朝晖[1] 黄燕[1] 

机构地区：[1]广州中医药大学附属广东省中医院脑血管病中心脑病三科,510120

出　　处：《介入放射学杂志》2011年第7期513-517,共5页Journal of Interventional Radiology

摘　　要：目的观察Gateway-Wingspan支架系统治疗症状性颅内动脉狭窄的安全性,以及防治再次脑卒中的疗效。方法应用Gateway-Wingspan支架系统治疗药物治疗无效的症状性颅内动脉狭窄患者36例(38处),其中择期手术32例,急诊手术4例。38处狭窄中22处位于后循环,16处位于前循环。结果术前平均狭窄程度为72.6%±12.6%,Gateway球囊扩张后残余狭窄33.8%±15.2%,Wingspan支架置入后残余狭窄23.6%±13.9%,治疗成功率为97.4%。4例发生围手术期并发症,其中择期手术置入支架32例,有2例发生并发症,急诊支架置入4例,有2例发生并发症。择期手术穿支动脉闭塞1例,导丝穿破大脑中动脉破裂出血1例;急诊手术支架内急性血栓形成2例,1例在介入术中发生,1例在支架置入后24 h发生。并发症发生率为11.1%(4/36)。1个月内再发同侧卒中2例,占5.5%(2/36)。在1～24个月(平均9.6个月)的随访中,30 d内脑卒中和31 d～1年同侧脑卒中的发生率为11.1%(4/36)。DSA复查10例,2例出现再狭窄,均位于大脑中动脉。结论 Gateway-Wingspan支架系统治疗症状性颅内动脉狭窄有较好的安全性和短期临床疗效,其长期疗效还需更大量样本及更长时间的随访研究,如何防治支架术后再狭窄需进一步的研究。Objective To discuss the safety of Gateway-Wingspan stent system in treating symptomatic intracranial atherosclerotic stenosis and its effect of preventing and treating cerebral ischemic events.Methods Interventional treatment by using Gateway-Wingspan sent system was carried out in 36 patients with symptomatic intracranial atherosclerotic arterial stenosis（a total of 38 lesions）who had failed to response the medication.Of the 32 cases,elective surgery was performed in 32 and emergent surgery in 4.Of the total 38 stenotic sites,22 were located at the posterior cerebral blood circulation region,while 16 at the anterior circulation region.Results The average degree of stenosis before stenting procedure was 72.6% ± 12.6%,the residual stenosis degree after balloon dilatation and stenting was 33.8% ± 15.2% and 23.6%±13.9%,respectively.The successful rate of treatment was 97.4%.Perioperative complications occurred in 4 patients,two from 32 cases who received elective surgery and other two from 4 cases who received emergent stent implantation.In cases receiving elective surgery,one suffered from perforating arterial branch occlusion and one occurred cerebral bleeding due to the rupture of middle cerebral artery caused by guide-wire.In patients receiving emergent stent implantation,acute stent thrombosis occurred in 2 cases during the interventional management（n = 1）or 24 hours after stent placement（n = 1）.The overall complication rate was 11.1%（4/36）.The 30-day composite ipsilateral stroke rate was 5.5% and the frequency of ipsilateral stroke within 30 days or ipsilateral stroke between 30 days and 12 months was 11.1%（4/36）during a mean follow-up time of 9.6 months（ranged between 1-24 months）.DSA check-up was conducted in 10 cases and restenosis at the middle cerebral artery was detected in 2 cases.Conclusion It is quite safe to use Gateway-Wingspan stent system for the treatment of symptomatic intracranial stenosis and its short-term clinical outcome is satisfactory,although further studies w

关 键 词：血管成形术 症状性颅内动脉狭窄 支架 

分 类 号：R743.4[医药卫生—神经病学与精神病学]