LVIS支架治疗颅内前循环动脉粥样硬化性狭窄效果分析  

Preliminary analysis of LVIS stent in the treatment of symptomatic intracranial atherosclerotic stenosis in anterior circulation

作　　者：唐海双 曾张伟 尚成浩 路智文 张小曦 左乔 许峰峰 李强 刘建民 黄清海 Tang Haishuang;Zeng Zhangwei;Shang Chenghao;Lu Zhiwen;Zhang Xiaoxi;Zuo Qiao;Xu Fengfeng;Li Qiang;Liu Jianmin;Huang Qinghai(Cerebrovascular Disease Center,First Affiliated Hospital of Naval Military Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院脑血管病中心 [2]海军军医大学第一附属医院海军特色医学中心

出　　处：《中国脑血管病杂志》2021年第8期518-523,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家重点研发计划(2016YFC1300703);国家自然科学基金(81971089、81771264、81771266);上海申康医院发展中心《促进市级医院临床技能与临床创新三年行动计划(2020—2022年)》重大临床研究项目(SHDC2020CR4037)。

摘　　要：目的探讨LVIS支架治疗症状性颅内前循环动脉粥样硬化性狭窄的安全性和有效性。方法回顾性连续纳入海军军医大学第一附属医院脑血管病中心2018年9月至2020年11月21例LVIS支架治疗的缺血性卒中患者病历资料,并经DSA和(或)MR血管成像(MRA)和(或)CT血管成像(CTA)证实为颅内前循环动脉粥样硬化性狭窄(狭窄率>70%)。记录患者临床症状、心脑血管疾病危险因素、最后一次症状发作到血管内治疗时间、前循环狭窄程度(支架治疗前后)、围手术期并发症、临床和影像学随访时间和预后。将血管狭窄程度按狭窄率90%~99%、80%~89%、70%~79%进行分层评价。评价狭窄病变特点、技术成功率、围手术期并发症(出血性并发症包括动脉穿孔、支架置入后脑高灌注出血等,缺血性并发症包括支架内血栓形成、病变部位栓子脱落造成血管栓塞等)、即刻治疗以及随访结果。即刻残余狭窄率<50%为支架成功覆盖狭窄病变。术后6个月对患者进行门诊或电话随访。影像学结果证实狭窄率≥50%定义为颅内动脉粥样硬化性狭窄复发,否则为稳定。临床随访主要评估缺血性卒中、反复短暂性脑缺血发作和死亡等不良事件。结果21例前循环颅内动脉粥样硬化性狭窄患者中,男14例(66.7%),女7例(33.3%);平均年龄(58±10)岁(35~74岁);临床表现包括同侧狭窄动脉的缺血性卒中12例(57.1%)、反复短暂性脑缺血发作9例(42.9%)。LVIS支架置入成功率为100%。支架置入术前狭窄率70%~99%,平均(88±9)%;术后残余狭窄率0~40%,中位残余狭窄率为0(0,10%)。术中发生缺血性并发症1例(4.8%),及时给予重组组织型纤溶酶原激活剂后血管成功再通。围手术期无死亡患者。21例(100%)患者均获得临床随访,平均随访时间(16±7)个月(6~30个月),最后一次临床随访未发生死亡、缺血性卒中事件、反复短暂性脑缺血发作。15例(71.4%)患者完成了影像学随访Objective To evaluate the safety and efficacy of LVIS stents in the treatment of symptomatic intracranial atherosclerotic stenosis(ICAS) in anterior circulation. Methods Medical records of 21 patients with ischemic stroke treated with LVIS from September 2018 to November 2020 in the Cerebrovascular Disease Center, First Affiliated Hospital of Naval Military Medical University, were retrospectively reviewed. ICAS(stenosis rate >70%) was confirmed by DSA and/or MR angiography(MRA) and/or CT angiography(CTA). Clinical symptoms, cardiovascular and cerebrovascular disease risk factors, time from the last symptom onset to endovascular treatment, degree of anterior circulation stenosis(before and after stent treatment), perioperative complications, clinical and imaging follow-up time, and prognosis were recorded. The degree of vascular stenosis was grouped according to the stenosis rate of 90%-99%, 80%-89% and 70%-79%. The characteristics of stenosis, technical success rate, perioperative complications(hemorrhagic complications including arterial perforation, cerebral hyperperfusion bleeding after stenting, and ischemic complications including stent thrombosis, vascular embolism caused by embolus dislodging from the lesion site, etc.), immediate treatment and follow-up results were evaluated. The immediate residual stenosis rate<50% was considered as successful stent coverage of stenosis. Patients were followed up by outpatient or telephone at 6 months postoperatively. A stenosis rate of ≥50% on imaging results was defined as recurrence of ICAS;otherwise, it was considered as stable. Clinical follow-up was used to assess adverse events such as ischemic stroke, recurrent transient ischemic attacks(TIA), and death.Results Among 21 patients with anterior circulation ICAS, 14 were males(66.7%) and 7 were females(33.3%). The mean age was(58±10) years(35-74 years). The clinical manifestations included ipsilateral ischemic stroke(12 cases, 57.1%) and recurrent TIA(9 cases, 42.9%). The success rate of LVIS stent implantation

关 键 词：LVIS支架 血管内治疗 动脉粥样硬化性狭窄 缺血性卒中 

分 类 号：R651.12[医药卫生—外科学]