Apollo支架治疗症状性基底动脉狭窄的短期疗效及安全性  

Short-term efficacy and safety of Apollo stent on symptomatic basilar artery stenosis

作　　者：周航 高永亮 王承汉 王正则[1] 高连波[1] Zhou Hang;Gao Yongliang;Wang Chenghan;Wang Zhengze;Gao Lianbo(Department of Neurology,the Fourth Hospital of China Medical University,Shenyang 110032,China)

机构地区：[1]中国医科大学附属第四医院神经内科,沈阳110032

出　　处：《中国医师杂志》2022年第11期1655-1660,共6页Journal of Chinese Physician

基　　金：辽宁省自然科学基金(2019-ZD-0784)。

摘　　要：目的评价Apollo支架治疗症状性基底动脉狭窄的短期疗效及安全性。方法选择2017年1月至2020年5月就诊于中国医科大学附属第四医院的症状性基底动脉狭窄并进行Apollo支架置入治疗的患者, 评估患者临床症状变化、手术成功率、术后并发症(包括症状性颅内出血、高灌注以及新发缺血性卒中)及3~6个月后的随访结果。结果共纳入96例患者, 均经造影证实存在与症状相对应的基底动脉重度狭窄, 其中88例患者进行支架置入治疗(置入Apollo支架86例, 自膨式支架2例), 成功率100%。86例Apollo支架置入患者中, 病变位于近段73例(84.88%)、中段10例(11.63%)、远段3例(3.49%), 狭窄程度(93.72±3.86)%, 狭窄长度(8.50±2.65)mm, 残余狭窄率(1.76±4.87)%, Mori A型病变80例、B型病变3例、C型病变3例。86例Apollo支架置入患者中, 围手术期神经系统并发症发生率为6.98%(6/86), 其中基底动脉近段1例(血管破裂), 基底动脉中段3例(穿支血管闭塞1例, 急性血栓形成血管闭塞2例), 远段2例(均为急性血管闭塞), 术中经微导管注入阿替普酶, 行接触性溶栓治疗, 即刻数字减影血管造影(DSA)显示血管开通, 遗留神经功能缺损者1例。所有患者未发生高灌注事件。对所有患者进行术后3个月的随访观察, 其中基底动脉近段预后良好58例, 中段预后良好18例, 远段预后良好4例, 预后不良6例(其中死亡1例)。术后支架再狭窄5例(5.81%), 再发卒中3例(3.49%), 其中致残性卒中1例(1.16%)。结论 Apollo支架治疗症状性基底动脉狭窄患者安全、有效, 短期预后好, 长期预后有待于进一步研究。Objective To evaluate the short-term efficacy and safety of Apollo stent in the treatment of symptomatic basilar artery stenosis.Methods Patients with symptomatic basilar artery stenosis admitted to the Fourth Affiliated Hospital of China Medical University from January 2017 to May 2020 were selected and treated with Apollo stent implantation.The changes of clinical symptoms and the success rate of operation were evaluated.Postoperative complications included symptomatic intracranial hemorrhage,hyperperfusion,and new ischemic stroke,and follow-up results were evaluated 3 to 6 months later.Results A total of 96 patients were included in this study,and all of them were confirmed by angiography to have severe basilar artery stenosis corresponding to the symptoms.Among them,88 patients received stent implantation,with a success rate of 100%.Among the 88 patients,86 received Apollo stent implantation,and 2 patients received self-Peng stent implantation.Among 86 patients with Apollo stent implantation,the lesions were located in the proximal segment in 73 cases(84.88%),in the middle segment in 10 cases(11.63%),and in the distal segment in 3 cases(3.49%).The degree of stenosis was(93.72±3.86)%,the length of stenosis was(8.50±2.65)mm,the residual stenosis rate was(1.76±4.87)%,and Mori type A lesions in 80 cases,type B lesions in 3 cases,and type C lesions in 3 cases.Among 86 patients with Apollo stent implantation,the incidence of perioperative neurological complications was 6.98%(6/86),including 1 case in the proximal part of the basilar artery(vascular rupture),3 cases in the middle part of the basilar artery(perforating artery occlusion in 1 case,acute thrombosis artery occlusion in 2 cases),and 2 cases in the distal part(both acute vascular occlusion).Alteplase was injected into the microcatheter during the operation,and contact thrombolysis was performed.Immediately digital subtraction angiography(DSA)showed that the blood vessels were opened,and 1 case with neurological deficit was left.No hyperperfusion occurre

关 键 词：椎底动脉供血不足 基底动脉狭窄 支架 

分 类 号：R651.12[医药卫生—外科学]