支架与药物治疗症状性颅内动脉狭窄远期疗效对比  

Stenting and drug therapy for symptomatic intracranial artery stenosis: comparison of long-term effects

作　　者：陈茹[1,2] 张念军[1] 赵敏[3] 郭建文[3] 张迎光[3] 马朝晖[3] 陈发军[3] 罗望池[3] 尤劲松[3] 李贵福[3] 蔡业峰[3] 黄燕[3] 

机构地区：[1]广州中医药大学,510405 [2]山东省临沂市中医医院 [3]广东省中医院脑病中心

出　　处：《介入放射学杂志》2016年第2期97-101,共5页Journal of Interventional Radiology

摘　　要：目的对比分析支架植入与药物治疗症状性中重度颅内动脉狭窄的远期随访疗效。方法采用回顾性研究、Kaplan-Meier法生存分析、Cox回归模型等统计方法,对199例症状性中重度颅内动脉狭窄患者经支架植入与单纯药物治疗的临床资料进行对比分析,比较两种治疗方式的安全有效性及近、远期获益差异。结果 Apollo、Wingspan、Solitaire支架植入成功率分别为100%、97.4%、98.5%,即刻残余狭窄分别由术前(70.20±12.02)%、(78.61±12.15)%、(78.44±11.82)%下降至术后(18.00±6.33)%、(23.65±10.71)%、(17.21±8.02)%。支架植入组9例(8.5%)发生围手术期并发症,其中术中栓子脱落、穿支闭塞4例,急性血栓形成1例,血管迷走神经反射2例,再灌注脑出血1例,术后第5天动脉-动脉栓塞事件1例。支架植入组与药物治疗组患者间主要终点事件发生率和累积发生率差异均无统计学意义(P=0.824,P=0.867)。结论 Solitaire支架和Wingspan支架植入治疗症状性颅内动脉狭窄均具有良好的安全有效性,远期获益与药物治疗相比无显著差异。Objective To compare long-term follow-up effect of stent implantation and drug therapy in treating moderate-severe symptomatic intracranial artery stenosis. Methods By using retrospective study, Kaplan-Meier analysis, Cox regression model and other statistical methods, the clinical data of 199 patients with moderate-severe symptomatic intracranial artery stenosis who received stent implantation or drug therapy were analyzed. The safety, effectiveness and short-term as well as long-term benefits were compared between the two therapies. Results The technical success rates of implantation of Apollo stent, Wingspan stent and Solitaire stent were 100%, 97.4% and 98.5% respectively. The instant residual stenosis were decreased from preoperative 70.2%±12.02%, 78.61%±12.15%, 78.44%±11.82% to postoperative 18.00%±6.33%, 23.65%± 10.71% and 17.21%±8.02% respectively. The perioperative complications in the stent group occurred in 9 patients （8.5%）, including perforating artery occlusion due to embolus falling off （n=4）, acute thrombus formation （n=l）, vasovagal reflex （n=2） and massive cerebral hemorrhage caused by reperfusion （n=l）, and five days after the treatment artery-artery embolism event occurred in one patient. No statistically significant differences in the incidence and cumulative incidence of the primary end point events existed between the stent group and the drug therapy group （P=0.824,P=0.867）. Conclusion In treating moderate-severe symptomatic intracranial artery stenosis, the use of Solitaire stent and Wingspan stent is very safe and effective, its long-term benefits are quite the same as drug therapy.

关 键 词：症状性颅内动脉狭窄 Wingspan支架 Solitaire支架 药物 

分 类 号：R743.3[医药卫生—神经病学与精神病学]