血管内介入治疗重度症状性颅内血管狭窄  

Endovascular interventional treatment for severe symptomatic intracranial artery stenosis

作　　者：万亮[1] 李轶[1] 荆朝晖[1] 杨晓笙[1] 华续明[1] 

机构地区：[1]上海交通大学医学院附属新华医院神经外科,200092

出　　处：《中国微侵袭神经外科杂志》2017年第3期105-108,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨应用Gateway球囊、Wingspan支架治疗重度症状性颅内血管狭窄的效果与技术要点。方法回顾性分析62例重度颅内血管狭窄病人的临床资料,术前血管狭窄率(75.15±10.70)%,神经功能缺损评分(NIHSS)为(2.50±3.31)分,改良Rankin量表评分(m RS)为(1.27±0.91)分。行单纯Gateway球囊扩张5例,球囊辅助Wingspan支架植入57例。随访3~14个月,平均8.7个月。结果本组病人球囊、支架均准确到位,术后狭窄率(17.69±10.12)%,术后NIHSS评分(1.23±1.92)分,m RS评分(0.97±1.10)分,与术前比较,差异均有统计学意义(P<0.05)。术后发生脑梗死4例,其中穿支梗死2例,抗血小板治疗相关梗死2例,经治疗后达m RS评分2~3分。5例单纯球囊扩张病人随访期间血管狭窄改善稳定,未发生脑梗死等相关并发症。结论血管内介入治疗重度症状性颅内血管狭窄安全、有效,单纯球囊扩张术可能对部分病人更有益。Objective To explore the effects and technical notes of Gateway balloon and Wingspan stent for the treatment of severe symptomatic intracranial artery stenosis （SIAS）. Methods Clinical data of 62 patients with severe SIAS were analyzed retrospectively, and the rate of artery stenosis was 75.15%± 10.70%, National Institute of Health stroke scale （NIHSS） score was 2.50 ± 3.31 and the modified Rankin scale （mRS） score was 1.27 ± 0.91 before the operation. Simple Gateway balloon dilatation was performed in 5 patients, while balloon-assisted Wingspan stenting was performed in 57. All the patients were followed up for a mean time of 8.7 months, ranged from 3 to 14 months. Results Balloons and stents were in the correct place in all the patients. The rate of artery stenosis, NIHSS and mRS scores were 17.69%± 10.12%, 1.23 ± 1.92 and 0.97 ± 1.10 respectively after the operation, and compared with the preoperation, the differences were found to be statistically significant （P〈0.05）. Postoperative cerebral infarction occurred in 4 patients, including perforator infarction in 2 and antiplatelet treatment related infarction in 2, and the mRS were achieved 2 to 3 scores after treatment in these patients. The artery stenosis was improved well in 5 patients with simple Gateway balloon dilatation, and no complication such as cerebral infarction occurred. Conclusions Endovascular interventional treatment is safe and effective for serve SIAS, while simple balloon dilatation may be more beneficial to some patients.

关 键 词：颅内血管狭窄 血管内治疗 Gateway球囊 Wingspan支架 

分 类 号：R651.12[医药卫生—外科学]