症状性颅内动脉粥样硬化性狭窄血管内支架成形术的价值  

Value of endovascular stenting for symptomatic intracranial artery stenosis

作　　者：蒋保华[1] 李兴[2] 周石[2] 宋杰[2] 蒋天鹏[2] 王黎洲[2] 

机构地区：[1]遵义市第一人民医院介入科,贵州遵义563000 [2]贵州医科大学附属医院介入科

出　　处：《实用放射学杂志》2015年第9期1522-1526,共5页Journal of Practical Radiology

摘　　要：目的：评价颅内动脉狭窄支架成形术（ICASS）治疗症状性颅内动脉狭窄的疗效、安全性和中期效果。方法观察21例症状性颅内动脉狭窄患者 ICASS 术后的手术成功率、狭窄改善率及并发症发生率；比较分析术前、术后（1、3、6、12个月及2年） NIHSS 和 MRS 量表评分的变化及随访期间缺血性脑血管事件的发生情况。结果1例因术中脑出血,手术被迫中止,20例手术成功,手术技术成功率95.2%,血管平均狭窄率从治疗前（73.4±7.9）%降为治疗后（13.7±9.2）%,围手术期并发症发生率为4.8%。9例术后6个月接受 DSA 检查,血管平均狭窄率为（29.5±12.2）%,未发现再狭窄病例；术后3、6、12个月及2年 NIHSS 评分、MRS 评分均较术前显著改善（均 P 〈0.05）；随访期间发现2例短暂性脑缺血（TIA）、1例非治疗靶血管区缺血性脑卒中（CI）。单因素比较分析发现：高龄（≥75岁）、高血压、糖尿病、血脂异常、入组事件至血管内治疗时间〉1个月、有2个以上独立危险因素、未系统进行基础疾病治疗的患者,术后易再发脑血管事件（均 P〈0.05）。结论ICASS 治疗症状性颅内动脉狭窄相对安全有效,中期疗效满意,需注意围手术期可能发生严重并发症。Objective To evaluate the curative effect,safety,and medium-term effect of intracranial artery stenosis stent （ICASS） for the treatment of the symptomatic intracranial artery stenosis.Methods ICASS was performed in 21 cases with the symptomatic intracranial artery stenosis.The stenting success rate,the improvement rate of stenosis post-stenting and the incidence of complications were observed.The change of the scores of the Modified Rankin Scale （MRS）and National Institutes of Health Stroke Scale （NIHSS）between pre-and post-stenting （1 month,3 months,6 months,12 months and 2 years）and the occurrence of ischemic cerebrovascular events after stenting were compared and analyzed respectively.Results Except one case failed because of intracranial hemorrhage during the operation,other 20 patients were treated with endovascular stent plasty successfully,the total technical achievement ratio was 95.2%.The aver-age stenosis ratio decreased from （73.4±7.9）% to （13.7±9.2）%.The complications incidence was 4.8% within the peroperative. 9 patients were reviewed with DSA in 6 months,the average ratio of stenosis was （29.5 ±12.2）%,no patient was found with the restenosis.Compared with pre-stenting,the score of MRS and NIHSS at the follow-up duration of 3 months,6 months,12 months and 2 years post-stenting of patients were significant improved （all P 〈 0.05 ）.During the follow-up period,2 patients were found with new transient ischemia attack （TIA）,1 patient had non-targeted vascular CI without other target vascular therapy-related com-plications.Univariate analysis indicated that patients with elderly （≥ 75 years old）,or hypertension,or diabetes,or dyslipidemia,or in the set of events to endovascular treatment for longer than 1 month,or with more than two independent risk factors for patients with underlying diseases treatment,or without systemic therapy,whom would be much more easily to reoccur the cerebrovascular events in post-operation（all P 〈0.05 ）.Conclusion ICASS should

关 键 词：支架成形术 颅内动脉狭窄 血管内治疗 

分 类 号：R815[医药卫生—放射医学] R743[医药卫生—临床医学]