药物洗脱球囊导管用于症状性大脑中动脉狭窄患者血管内介入治疗的初步观察  

Preliminary observation of drug-eluting balloon catheter for endovascular treatment of symptomatic middle cerebral artery stenosis

作　　者：王黎[1] 李瑞[1] 朱余友 孙文[1] 张超[1] 刘天龙 宋建龙 胡伟[1] Wang Li;Li Rui;Zhu Yuyou;Sun Wen;Zhang Chao;Liu Tianlong;Song Jianlong;Hu Wei(Comprehensive Stroke Center,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)脑血管病中心,合肥230001

出　　处：《中国临床保健杂志》2023年第2期166-170,共5页Chinese Journal of Clinical Healthcare

基　　金：安徽省自然科学基金项目(2108085MH272)。

摘　　要：目的观察药物洗脱球囊治疗症状性大脑中动脉粥样硬化性狭窄的有效性和安全性。方法选取2020年6月至2021年12月符合入组标准(大脑中动脉狭窄率≥70%)的患者40例,采用药物洗脱球囊对血管狭窄部位进行扩张治疗;药物球囊扩张前均先进行普通球囊进行预扩张,并在术后7 d内或出院时、术后30 d、术后6个月进行临床随访,术后半年随访时通过全脑血管造影术(DSA)检查评价患者靶病变血管再狭窄情况。结果40例患者中共有40处大脑中动脉狭窄,所有狭窄部位均成功进行大脑中动脉药物洗脱球囊扩张术,无颅内出血及死亡发生,有5例患者发生术后新发梗死,属于轻型卒中,出院时美国国立卫生研究院卒中量表(NIHSS)评分明显改善;术前靶血管狭窄率86.9%±8.7%,8例患者术后无明显残留血管狭窄,32例患者术后残留狭窄率为12.5%(5%,20%);其中27例患者术后正向血流明显改善,13例患者需支架补救,主要原因为靶血管目标部位药物球囊扩张后发现动脉夹层不能维持有效正向血流。目前随访时间(8.9±2.1)月,随访中均未再出现缺血性脑卒中发生。40例患者均完成6个月随访,其中39例行全脑血管造影复查,1例行头颈部CT血管造影(CTA)复查;6个月再狭窄率17.5%(7/40,其中单纯药物球囊后5例,支架补救2例)。结论药物洗脱球囊治疗症状性大脑中动脉粥样硬化性狭窄可能是一个相对有效和安全的治疗选择。Objective To assess the efficacy and safety outcomes of Drug-coated balloon(DCB)angioplasty without stenting for symptomatic middle cerebral artery(MCA)stenosis.Methods Between June 2020 and December 2021,details of 40 patients with 40 arteries treated with DCBs for symptomatic severe intracranial atherosclerotic disease(≥70%stenosis but except chronic total occlusion)were retrospectively collected in our hospital.All lesions were predilated with conventional balloons.Periprocedural complications and clinical and vascular imaging follow up outcomes were analyzed at different time including 7days or discharge,one month and six months.Results Forty arteries(40 patients)were successfully dilated with DCBs totally and 27(67.5%)arteries achieved good antegrade perfusion,with remedial stenting for 13 arteries owing to vessel dissection mainly.No intracranial hemorrhage and death occurred.5 patients presented with new ischemic stroke after the procedure,all were minor stroke with no disability in follow up.The average percentages of stenosis of the lesions were 86.9%±8.7%before treatment,12.5%(IQR:5%-20%)after DCB angioplasty in 32 lesions,and 8 lesions with no stenosis left after procedure.Over a mean follow-up of(8.9±2.1)months,no patient had recurrent ischemic symptoms.Repeat vascular imaging was performed at 6 months later after each procedure,with cerebral angiography in 39 patients(39 arteries)and CT angiography in one patient(one artery).Stenosis over 50%was present in 7 lesions(17.5%,7/40)presented with angiographic asymptomatic restenosis during the follow-up period.Conclusion This study suggests that DCB dilatation may be safe and effective for symptomatic middle cerebral artery stenosis disease.

关 键 词：大脑动脉疾病 卒中 大脑中动脉 药物洗脱球囊 血管成形术 

分 类 号：R743[医药卫生—神经病学与精神病学]