52例症状性颅内动脉粥样硬化性狭窄患者个体化血管内治疗的回顾性分析  

Individualized endovascular treatment for 52 patients with symptomatic intracranial atherosclerotic stenosis:a retrospective analysis

作　　者：华敏[1] 王佳佳[1] 陈文亚[1] 刘志清[1] 马爱金[1] 张金[1] 许元丰[1] 毛伦林[1] HUA Min;WANG Jiajia;CHEN Wenya;LIU Zhiqing;MA Aijin;ZHANG Jin;XU Yuanfeng;MAO Lunlin(Department of Neurology,Wujin Hospital Affiliated to Jiangsu University,Wujin Clinical College of Xuzhou Medical University,Changzhou 213017,Jiangsu,China)

机构地区：[1]江苏大学附属武进医院神经内科,徐州医科大学武进临床学院,常州213017

出　　处：《海军军医大学学报》2024年第4期520-526,共7页Academic Journal of Naval Medical University

基　　金：常州市武进区科技计划(社会发展)项目(WS201945);常州市卫生健康委员会科技项目(WZ201932,QN202339).

摘　　要：目的评估症状性颅内动脉粥样硬化性狭窄(sICAS)患者个体化血管内治疗的安全性和有效性。方法回顾性收集2019年1月至2022年12月在我院接受个体化血管内治疗的sICAS患者的临床资料,分析血管重建成功率、围手术期并发症发生率和死亡情况,以及随访期间复发性缺血性脑卒中(IS)、短暂性脑缺血发作、死亡和血管再狭窄的发生率。结果52例sICAS患者共有55处病变,均接受血管内治疗。患者平均年龄为(62.94±9.04)岁。术前病变血管狭窄程度为90%(80%,99%),狭窄长度为8(5,11)mm。采用的手术方式分别为球囊扩张式支架植入术(25例,27个病变)、自膨式支架植入术(19例,20个病变)、单纯球囊扩张血管成形术(8例,8个病变)。术后残余狭窄程度为10%(0,20%),较术前降低且差异有统计学意义(P<0.001)。血管重建成功率为94.23%(49/52),围手术期并发症发生率为3.85%(2/52)。临床随访12(12,18)个月,影像学随访10(6,12)个月,血管再狭窄发生率为7.69%(4/52),复发性IS发生率为1.92%(1/52),无患者死亡。结论个体化血管内治疗对sICAS安全、有效,其可提高血管重建成功率,降低围手术期并发症、远期IS复发和再狭窄风险。Objective To investigate the safety and efficacy of individualized endovascular treatment in patients with symptomatic intracranial atherosclerotic stenosis(sICAS).Methods The clinical data of sICAS patients who received individualized endovascular treatment in our hospital from Jan.2019 to Dec.2022 were retrospectively collected.The success rate of revascularization,the perioperative complications and death,and the incidence of recurrent ischemic stroke(IS),transient ischemic attack,death and restenosis during follow-up were analyzed.Results There were 55 lesions of 52 sICAS patients,and they all received endovascular treatment.The mean age was(62.94±9.04)years old.The preoperative stenosis severity was 90%(80%,99%)and the stenosis length was 8(5,11)mm.The surgical methods were balloon-mounted stenting(25 cases,27 lesions),self-expanding stenting(19 cases,20 lesions),and simple balloon dilation angioplasty(8 cases,8 lesions).The postoperative residual stenosis severity was 10%(0,20%),which was significantly lower than that before surgery(P<0.001).The success rate of revascularization was 94.23%(49/52).The incidence of perioperative complications was 3.85%(2/52).The clinical follow-up time was 12(12,18)months and the imaging follow-up time was 10(6,12)months.During the follow-up period,the incidence of vascular restenosis was 7.69%(4/52),the incidence of recurrent IS was 1.92%(1/52),and there was no death.Conclusion Individualized endovascular treatment is safe and effective for sICAS patients.It can improve the success rate of revascularization and reduce perioperative complications,long-term recurrence rate of IS and risk of restenosis.

关 键 词：颅内动脉粥样硬化性狭窄 缺血性脑卒中 血管内治疗 球囊扩张血管成形术 支架植入 

分 类 号：R743[医药卫生—神经病学与精神病学]