急性前循环动脉粥样硬化性串联闭塞患者球囊扩张与支架置入的效果  

The efficacy of balloon dilation angioplasty and stent implantation in treating patients with acute anterior tandem occlusion caused by internal carotid artery atherosclerosis

作　　者：李威[1] 冯晓丽 王康萌 黄开来 孙刚 陈蓉[1] 赵振强[1] 关海涛[2] LI Wei;FENG Xiaoli;WANG Kangmeng;HUANG Kailai;SUN Gang;CHEN Rong;ZHAO Zhenqiang;GUAN Haitao(Department of Neurology,First Affiliated Hospital,Hainan Medical College,Haikou,Hainan Province 570105,China)

机构地区：[1]海南医学院第一附属医院神经内科,海南海口570105 [2]广州医科大学附属第三医院神经内科

出　　处：《介入放射学杂志》2024年第6期593-598,共6页Journal of Interventional Radiology

基　　金：海南省自然科学基金高层次人才项目(2019RC379)。

摘　　要：目的比较颈内动脉起始段粥样硬化性串联闭塞患者颈内动脉颅外段行球囊扩张或支架置入的安全性和有效性。方法纳入2018年1月至2022年10月海南医学院第一附属医院和广州医科大学附属第三医院收治的发病24 h内行血管内治疗的急性前循环串联闭塞脑卒中患者91例,分为球囊扩张组51例,支架置入组40例,比较两组基线和临床资料。mTICI 2b~3定义为血管良好再通,术后90 d改良Rankin量表(mRS)评分0~2分定义为临床预后良好。结果支架组患者术后血管良好再通率和90 d良好临床预后率较球囊组高,分别为70%比60.8%和60%比52%,但差异无统计学意义(P=0.361、0.391)。两组症状性颅内出血发生率、无症状性颅内出血发生率和病死率分别为10%比11.8%、32.5%比41.2%、22.5%比17.7%,差异均无统计学意义(P=1.000、0.396、0.564)。结论颈内动脉起始段动脉粥样硬化性病变所致的急性前循环串联闭塞患者,急性期颅外段行球囊扩张或支架置入可能均安全有效。Objective To compare the safety and efficacy of emergency balloon dilation angioplasty with emergency stent implantation in treating patients with acute anterior tandem occlusion caused by atherosclerosis at the starting segment of the internal carotid artery.Methods A total of 91 patients with stroke caused by acute anterior tandem occlusion,who were admitted to the First Affiliated Hospital of Hainan Medical College and the Third Affiliated Hospital of Guangzhou Medical University of China within 24 hours after disease onset to receive treatment from January 2018 to October 2022,were enrolled in this study.The patients were divided into balloon dilation angioplasty group(balloon dilation group,n=51)and stent implantation group(stenting group,n=40).The basic clinical data were compared between the two groups.The modified thrombolysis in cerebral infarction(mTICI)grade 2b-3 was defined as a good recanalization.The postoperative 90-day modified Rankin scale(mRS)score of 0-2 points was defined as a good clinical prognosis.Results The good recanalization rate and postoperative 90-day good clinical prognosis rate in the stenting group were 70%and60%respectively,which were higher than 60%and 52%respectively in the balloon dilation group,and the differences between the two groups were not statistically significant(P=0.361 and P=0.391 respectively).The incidences of symptomatic intracranial hemorrhage(sICH),asymptomatic intracranial hemorrhage(aSICH),and mortality in the stenting group were 10%,32.5%,and 22.5%respectively,which in the balloon dilation group were 11.8%,41.2%,and 17.7%respectively,and the differences between the two groups were not statistically significant(P=1.000,P=0.396,and P=0.564 respectively).Conclusion For the treatment of patients with acute anterior tandem occlusion caused by atherosclerosis at the starting segment of the internal carotid artery,both emergency balloon dilation angioplasty or stent implantation are clinically safe and effective.

关 键 词：急性前循环串联闭塞 动脉粥样硬化性病变 球囊扩张 支架置入 血管内治疗 

分 类 号：R651.12[医药卫生—外科学]