血管内成形术治疗症状性非急性期颅内动脉狭窄或闭塞的临床疗效  

Efficacy of endovascular angioplasty for non-acute symptomatic intracranial artery stenosis or occlusion

作　　者：文立利 王森 唐晓宇[3] 吴琪 周龙江[4] 周晓明 张鑫 WEN Li-li;WANG Sen;TANG Xiao-yu(Department of Neurosurgery,Sir Run Run Hospital,Nanjing Medical University,Nanjing 211112,China)

机构地区：[1]南京医科大学附属逸夫医院神经外科,南京211112 [2]中国人民解放军东部战区总医院神经外科 [3]苏州市立医院神经外科 [4]扬州大学附属医院介入科

出　　处：《临床神经外科杂志》2022年第4期417-421,426,共6页Journal of Clinical Neurosurgery

基　　金：江苏省博士后研究计划课题基金资助项目(2019k281);江苏省自然科学基金面上项目(BK20191231)。

摘　　要：目的分析症状性非急性期颅内动脉狭窄或闭塞血管内成形术的有效性与安全性。方法回顾性分析2016年7月—2020年6月东部战区总医院收治的44例症状性非急性期颅内动脉狭窄或闭塞患者的临床资料。44例患者包括45处病变,颈内动脉颅内段狭窄3例,闭塞3例,大脑中动脉M1段狭窄18例,闭塞7例,基底动脉狭窄7例,椎动脉颅内段狭窄7例。所有患者均行血管内成形术。通过分析介入治疗效果以及6个月临床功能与影像结果评估血管内成形术的疗效。结果44例患者共行45次手术,均成功进行血管内成形术,无一例失败。球囊扩张+一期支架植入术44次,单纯球囊扩张术+二期支架植入术1次。围手术期发生缺血性事件3例,出血性事件4例。4例患者出院时mRS下降,包括死亡1例。37例临床随访患者中35例(94.6%)表现为预后良好,1例出现卒中复发事件。31例影像学随访患者中28例(90.3%)无再狭窄或闭塞,1例轻度狭窄,2例重度狭窄。结论血管内成形术是治疗症状性非急性期颅内动脉狭窄或闭塞的安全、有效的方法,但仍需进一步降低围手术期并发症。Objective To analyze the efficacy and safety of endovascular angioplasty for non-acute symptomatic intracranial artery stenosis or occlusion.Methods The clinical data of 44 patients with non-acute symptomatic intracranial artery stenosis or occlusion treated in Department of Neurosurgery,General Hospital of the Eastern War Zone from July 2016 to June 2020 were analyzed retrospectively.There were 45 lesions in 44 patients including 3 cases of stenosis and 3 of occlusion at intracranial segments of internal carotid artery,18 cases of stenosis and 7 of occlusion at M1 of middle cerebral artery,7 cases of stenosis at basilar artery stenosis and 7 of stenosis at intracranial segments of vertebral artery.All patients underwent endovascular angioplasty.The efficacy and safety of angioplasty were evaluated by analyzing the effect of clinical therapy,6-month clinical outcome and angiographic results.Results Endovascular angioplasty was successfully performed in 44 patients without failure.Balloon dilatation combined with stent implantation was performed in 44 patients(97.8%),simple balloon dilatation with secondary stent implantation was performed in 1 patient(2.2%).Ischemic events occurred in 3 patients(6.7%)and hemorrhagic events in 4 patients(8.9%).mRS score decreased in 4 patients(9.1%)at discharge,including one death.Among the 37 clinical follow-up patients,35(95%)showed good prognosis and 1(2.7%)had stroke recurrence.Among the 31 angiographic follow-up patients,28(90.3%)had no restenosis or occlusion,1 case had mild stenosis and 2 cases had severe stenosis.Conclusions Endovascular angioplasty may be a safe and effective approach for non-acute symptomatic intracranial artery stenosis or occlusion,but the perioperative complications still need to be reduced further.

关 键 词：颅内动脉 狭窄 闭塞 动脉粥样硬化 血管内成形术 

分 类 号：R651[医药卫生—外科学]