Neuroform EZ支架用于大脑中动脉重度狭窄血管内治疗临床分析  

Effect of Neuroform EZ stents on severe middle cerebral artery stenosis and the incidence of end-point events

作　　者：周静[1] 温昌明[1] 李连冲 余洋 张保朝[1] 杨银雪 ZHOU Jing;WEN Changming;LI Lianchong;YU Yang;ZHANG Baochao;YANG Yinxue(Nanyang Central Hospital,Nanyang 473000,China;The First Affiliated Hospital of Nanyang Medical College,Nanyang 473000,China)

机构地区：[1]南阳市中心医院,河南南阳473000 [2]南阳医专一附院,河南南阳473000

出　　处：《中国实用神经疾病杂志》2021年第17期1516-1522,共7页Chinese Journal of Practical Nervous Diseases

基　　金：河南省科技发展计划项目(编号:192102310349);南阳市科技发展计划项目(编号:KJGG2018082)。

摘　　要：目的观察Neuroform EZ支架用于大脑中动脉(MCA)重度狭窄的效果及终点事件发生率。方法选取2017-06—2019-08南阳市中心医院96例MCA M1段重度狭窄患者为研究对象,均给予脑数字减影血管造影(DSA)检查,明确存在MCA重度狭窄(70%~99%),并在全麻下行Neuroform EZ支架置入治疗。术后分别于3、6、9个月时住院复查DSA,12个月时门诊随访,检查患者颅内是否有支架内狭窄及手术血管相关的缺血性血管疾病情况。结果96例患者均获得技术成功(支架完全覆盖靶病变,且残余狭窄<40%),血管狭窄率由(84.99±6.97)%降为(17.89±6.70)%。其中1例患者于术后2 d发生颅内出血,临床表现为头痛、烦躁及进行性意识障碍等,经积极治疗后仍于术后第3天死亡。主要终点事件发生率为1.04%(1/96),次要事件的终点发生率为0。随访3~12个月,平均7.7个月。16例患者依从性差或拒绝复查脑血管造影,79例完成随访,随访率为83.15%。随访结束后,79例患者DSA随访,出现大脑中动脉支架内再次狭窄(DSA证实>50%的支架内狭窄)占5.06%(4/79),余94.93%(75/79)未发现大脑中动脉内M1段支架变形、塌陷、断裂、移位及支架置入后再狭窄等情况,与手术血管相关的缺血性血管疾病均未发现。结论Neuroform EZ支架置入术的终点事件发生率较低,支架再狭窄率更低,效果更好,是治疗MCA重度狭窄的有效手段。Objective To observe the effect of Neuroform EZ stents on severe middle cerebral artery stenosis and the incidence of end-point events.Methods From June 2017 to August 2019,96 patients with severe MCA M1 stenosis were enrolled.Digital subtraction angiography(DSA)was performed in all patients,70%-99%of severe MCA stenosis were found,and Neuroform EZ stents were implanted under general anesthesia.After 3,6,9,12 months,DSA was rechecked in hospital to check whether there was intracranial stent stenosis.Results The rate of stenosis decreased from(84.99±6.97)%to(17.89±6.70)%.Among them,1 patient developed intracranial hemorrhage 2 days after surgery with clinical manifestations of headache,irritability and progressive disturbance of consciousness,etc.,and still died 3 days after surgery after active treatment.The primary endpoint event rate was1.04%(1/96),and the secondary endpoint event rate was 0.The visit lasted from 3 to 12 months,with an average of 7.7 months.Sixteen patients had poor compliance or refused to recheck cerebral angiography,and 79 patients were followed up,with a follow-up rate of 83.15%.After the follow-up,the 79 patients were followed up by DSA,and 4 patients showed re-stenosis in the middle cerebral artery stent(>50%of the stent stenosis confirmed by DSA),while no deformation,collapse,fracture,displacement or re-stenosis after stent placement in the M1 segment of the middle cerebral artery was found in the remaining 75 patients.No ischemic vascular disease associated with surgical vessels was found in any of the patients.Conclusion Neuroform EZ stenting has a lower incidence of end-point events,a lower rate of stenting stenosis,and a better outcome,and is an effective way to treat severe MCA stenosis.

关 键 词：大脑中动脉狭窄 Neuroform EZ支架 支架置入术 支架置入后再狭窄 终点事件 

分 类 号：R743[医药卫生—神经病学与精神病学]