颅内支架置入术治疗重度颅内动脉粥样硬化性狭窄182例临床分析  

Clinical analysis of 182 cases with severe intracranial atherosclerotic stenosis treated with intracranial stent implantation

作　　者：刘涛[1] 袁晨 张庆荣 凌海平 许天助 杭春华 庄宗 那世杰[1] LIU Tao;YUAN Chen;ZHANG Qingrong(Departement of Neurosurgery,Affiliated Drum Tower Hospital,Nanjing University Medicine School,Nanjing 210009,CHINA)

机构地区：[1]南京大学医学院附属鼓楼医院神经外科,江苏210009 [2]苏州大学附属第一医院介入科

出　　处：《江苏医药》2021年第4期336-340,共5页Jiangsu Medical Journal

基　　金：国家自然科学基金(81971127)。

摘　　要：目的分析颅内支架置入术治疗重度颅内动脉粥样硬化性狭窄(ICAS)的有效性及安全性。方法行颅内支架置入术的重度ICAS患者182例,入院时改良Rankin量表(mRS)评分≤2分138例,>2分44例。术后6个月行影像学随访观察支架内再狭窄的发生情况。术后1年再次行mRS评分。记录患者术后30 d及1年的临床终点事件发生情况。结果182例患者共置入198枚颅内支架;其中,Wingspan支架61枚,Solitaire AB支架135枚,Neuroform EZ支架2枚。手术成功率为100%。1处术后残余狭窄25%,149处术后残余狭窄10%~15%,48处术后残余狭窄<10%。对137例患者随访1年,术后30 d发生临床终点事件6例,术后1年发生累积临床终点事件15例。56例患者(61处狭窄)接受影像学随访,51例行DSA,5例行CT血管造影;其中,14例患者18处发生支架内再狭窄,12处为轻度狭窄,4处为中度狭窄,2处为重度狭窄。术后1年mRS评分≤2分126例,>2分11例。结论颅内支架置入术治疗重度ICAS安全、有效,临床终点事件和支架内再狭窄发生率较低,患者神经功能恢复较好。Objective To analyze the effectiveness and safety of intracranial stent implantation for severe intracranial atherosclerotic stenosis(ICAS).Methods The intracranial stent implantation was performed in 182 patients with severe ICAS,of whom 138 cases were with the modified Rankin scale(mRS)score of≤2 points and 44 cases were with mRS score of>2 points after admission.The mRS score was reevaluated one year after operation.The incidence of in-stent restenosis was followed up by imaging 6 months after operation.The clinical endpoint events of 30 days and one year after operation were recorded.Results One hundred and ninety-eight stents were implanted in 182 patients,including 61 Wingspan stents,135 Solitaire AB stents and 2 Neuroform EZ stents.The success rate of operation was 100%.Postoperative residual stenosis of 25%was found at one place,that of 10%-15%at 149 places,and that of less than 10%at 48 places.One hundred and thirty-seven patients were followed up for 1 year,which showed that clinical endpoint events occurred in 6 cases in 30 days after operation and in 15 cases in one year after operation.Imaging follow-up(DSA in 51 cases,CT angiography in 5 cases)was performed in 56 patients(61 stenosis),which showed that in-stent restenosis was seen at 18 places in 14 cases,including mild stenosis in 12 cases,moderate stenosis in 4 cases and severe stenosis in 2 cases.One year after operation,126 cases had a mRS score of≤2 points and 11 cases had a mRS score of>2 points.Conclusion Intracranial stent implantation for severe ICAS is safe and effective with lower incidence of clinical endpoint events and in-stent restenosis and better recovery of the neurological function.

关 键 词：颅内动脉粥样硬化性狭窄 颅内支架置入术 

分 类 号：R743[医药卫生—神经病学与精神病学]