Wingspan支架治疗颅内动脉狭窄有效性和安全性的单中心研究  

The effectiveness and safety of Wingspan stenting for intracranial artery stenosis: a single-center study

作　　者：王震宇 蒋业清 黄磊 葛亮 张晓龙 WANG Zhenyu;JIANG Yeqing;HUANG Lei;GE Liang(ZHANG Xiaolong.Department of Radiology,Affiliated Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院放射科,上海200040

出　　处：《介入放射学杂志》2020年第8期748-752,共5页Journal of Interventional Radiology

摘　　要：目的探讨颅内动脉狭窄血管内治疗的安全性和有效性,以及术后即刻残余狭窄率与远期临床预后的相关性。方法回顾性分析2014年1月至2018年6月在复旦大学附属华山医院接受Wingspan支架治疗的59例(62处)颅内动脉狭窄患者。评价手术技术成功率、手术前后血管狭窄率、手术相关并发症及转归。比较术后即刻高残余狭窄率组(>30%)和低残余狭窄率组(≤30%)手术相关并发症及临床预后的差异。结果手术技术成功率为93.5%(58/62)。术后即刻残余狭窄率为(22.5±9.7)%,较术前(60.8±7.8)%明显改善(P<0.001)。发生手术相关并发症6例(10.2%,6/59),其中术中出血2例,血栓形成1例,夹层形成2例,术后再灌注损伤出血1例;5例术中并发症患者出院时改良Rankin量表(mRS)评分未增加,1例术后再灌注损伤患者病情稳定后转外院康复治疗。53例患者(89.8%,53/59)获平均(18±14)个月临床随访,随访时平均mRS评分(0.83±1.40)分较入院时(1.63±0.98)分显著改善(P<0.01);平均Barthel指数评分(87±17)分较入院时(69±20)分显著升高(P<0.001)。51处狭窄病变(82.3%,51/62)获平均(15±13)个月影像学随访,3处(5.88%,3/51)出现支架内再狭窄(ISR),其中1处(1.96%,1/51)再治疗。与术后即刻低残余狭窄率组相比,高残余狭窄率组中更多见椎-基底动脉汇合处狭窄患者(P<0.05)、高术中并发症率患者(P<0.05)和高手术风险患者(P=0.08)。但两组远期随访mRS评分和日常生活活动能力等级差异无统计学意义。结论Wingspan支架治疗颅内动脉狭窄安全有效。术后即刻高残余狭窄率可能与椎-基底动脉汇合处狭窄、高手术风险、高术中并发症发生率相关,但并不能作为预测血管内治疗远期临床预后的预测指标。Objective To investigate the safety and effectiveness of endovascular treatment for intracranial artery stenosis,and to analyze the correlation between the postoperative instant residual stenosis rate(RSR)and the long-term clinical prognosis.Methods The clinical data of 59 patients with intracranial artery stenosis(62 stenosed arteries in total),who were admitted to the Affiliated Huashan Hospital of Fudan University of China to receive Wingspan stenting therapy between January 2014 and June 2018,were retrospectively analyzed.The operation success rate,the stenosis rate before and after operation,the operation-related complications and the patient’s prognosis were evaluated.The operation-related complications and the clinical prognosis were compared between the high residual stenosis rate(RSR)group(>30%)and low RSR group(≤30%).Results The technical success rate was 93.5%(58/62).The postoperative instant residual stenosis rate was(22.5±9.7)%,which was obviously better than preoperative(60.8±7.8)%,the difference was statistically significant(P<0.001).Operation-related complications occurred in 6 patients(10.2%,6/59),including intraoperative bleeding(n=2),thrombosis(n=1),arterial dissection(n=2),bleeding due to postoperative reperfusion injury(n=1).Five patients developed intraoperative complications,their modified Rankin scale(mRS)scores at discharge were not increased.One patient,who had postoperative reperfusion injury,was transferred to rehabilitation therapy after his condition became stable.Fifty-three patients(89.8%,53/59)were followed up for a mean period of(18±14)months,their mean mRS score was(0.83±1.40)points,which was remarkably improved when compared with(1.63±0.98)points at admission(P<0.01),and the Barthel index was(87±17)points,which was significantly higher than(69±20)points at admission(P<0.01).A total of 51 stenosed lesions(82.3%,51/62)were followed up with imaging examination for a mean period of(15±13)months,in-stent restenosis(ISR)was found in 3 lesions(5.88%,3/51),one of the 3 ISRs

关 键 词：颅内动脉狭窄 术后即刻残余狭窄率 有效性 安全性 

分 类 号：R743.4[医药卫生—神经病学与精神病学]