颅内动脉粥样硬化性狭窄自膨胀式支架治疗术后不良事件及再狭窄的危险因素分析  

Risk factors analysis of adverse events and restenosis after self-expandable stent therapy for intracranial atherosclerotic stenosis

作　　者：孙博文[1] 凌冶平 吴培[1] 张广[1] 王春雷[1] 郑秉杰[1] 史怀璋[1] 徐善才[1] Sun Bowen;Ling Yeping;Wu Pei;Zhang Guang;Wang Chunlei;Zheng Bingjie;Shi Huaizhang;Xu Shancai(Department of Neurosurgery,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院神经外科,150001

出　　处：《中国脑血管病杂志》2023年第3期159-167,211,共10页Chinese Journal of Cerebrovascular Diseases

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.2021-04-61)。

摘　　要：目的探究自膨胀式支架治疗颅内动脉粥样硬化性狭窄(ICAS)术后出现不良事件及再狭窄的危险因素。方法回顾性连续纳入2017年6月至2020年6月哈尔滨医科大学附属第一医院神经外科应用自膨胀式支架(Enterprise、Wingspan支架)治疗的ICAS患者。记录患者基线资料、实验室检查及影像检查资料(病变部位、术前狭窄程度、狭窄长度及Mori分型、术后残余狭窄率等)及治疗相关资料(手术时间以及支架和球囊品牌、类型及直径),观察术后即刻支架移位及血栓形成发生情况,术后30 d内根据患者的临床表现及影像学检查判断有无手术相关卒中(出血性卒中、缺血性卒中)、短暂性脑缺血发作或死亡等安全性结局发生。术后定期通过电话或门诊进行临床随访,术后6个月后,通过DSA或CT血管成像(CTA)或MR血管成像(MRA)检查进行影像学随访,观察与置入支架的责任区域相关的缺血性事件(缺血性卒中、短暂性脑缺血发作)、死亡及支架内再狭窄(ISR,狭窄率≥70%)情况。应用单因素分析及多因素Logistic回归分析研究影响术后30 d内安全性结局及随访时ISR发生的因素。结果共纳入311例患者,女106例(34.1%),男205例(65.9%);平均年龄(58±9)岁。术前平均狭窄率为(86±8)%,平均狭窄长度为(10±4)mm。手术均成功,无术后即刻支架移位及血栓形成,术后平均残余狭窄率为(25±9)%。术后30 d内发生与手术相关的任何卒中或死亡27例(8.7%),其中蛛网膜下腔出血9例,脑实质出血7例,缺血性卒中11例,1例出血性卒中患者死亡。单因素分析结果显示,合并糖尿病、冠心病与术后30 d内安全性结局事件发生相关(均P<0.05),多因素Logistic回归分析并未发现与术后30 d内安全性结局相关的独立危险因素。281例(90.9%)患者接受临床随访,随访中位时间375(320,480)d,发生与责任区域相关的缺血性事件23例(8.2%;缺血性卒中12例,短暂性脑缺血发作11�Objective To explore the risk factors of adverse events and restenosis after the treatment of intracranial atherosclerotic stenosis(ICAS)with the self-expandable stent.Methods ICAS patients treated with self-expandable stents(Enterprise or Wingspan stents)in the Neurosurgery Department of the First Affiliated Hospital of Harbin Medical University from June 2017 to June 2020 were included retrospectively.Records of the patient′s baseline data,laboratory examination,and imaging examination data(lesion site,preoperative stenosis degree,stenosis length and Mori classification,postoperative residual stenosis rate,etc.)and treatment-related data(operation time,brand,type and diameter of stent and balloon),the occurrence of stent displacement and thrombosis immediately after procedure,and safety outcome of surgery-related stroke(hemorrhagic stroke,ischemic stroke),transient ischemic attack or death within 30 days after procedure according to the clinical manifestation and imaging examination.The patients were followed up regularly by telephone or outpatient service after procedure.After 6 months,the patients were followed up by DSA or CT angiography(CTA)or MR angiography(MRA)to observe the ischemic events(ischemic stroke,transient ischemic attack),death and in-stent restenosis(ISR,stenosis rate≥70%)related to the responsible area of stent implantation.Univariate analysis and multivariate Logistic regression analysis were used to study the factors affecting the safety outcome and the occurrence of ISR within 30 days after procedure.Results A total of 311 patients were included,including 205 males(65.9%)and 106 females(34.1%);The average age was(58±9)years old.The average preoperative stenosis rate was(86±8)%,and the average stenosis length was(10±4)mm.All procedures were successful without stent displacement and thrombosis immediately after procedure.The average residual stenosis rate was(25±9)%.There were 27 cases(8.7%)of any stroke or death related to procedure within 30 days after surgery,including 9 cases of

关 键 词：颅内动脉粥样硬化性狭窄 血管内治疗 自膨胀式支架 围手术期并发症 支架内再狭窄 

分 类 号：R651.11[医药卫生—外科学]