单纯球囊扩张血管成形术治疗症状性大脑中动脉狭窄的疗效  

Clinical efficacy of simple balloon angioplasty for patients with symptomatic middle cerebral artery stenosis

作　　者：张晓杰 成晓江[3] 于谦 赵兴军 杜忠德 刘鹏 辛国强 ZHANG Xiao-jie;Cheng Xiao-jiang;YU Qian;ZHAO Xing-jun;DU Zhong-de;LIU Peng;XIN Guo-qiang(Department of Brain Center,Sunshine Union Hospital,Weifang 261000,China;Department of Neurosurgery,The First Affiliated Hospital of Xinjiang Medical University,830054 Urumqi,China)

机构地区：[1]阳光融和医院脑科中心,山东潍坊261000 [2]新疆医科大学第一附属医院神经外科,乌鲁木齐830054 [3]不详

出　　处：《中国临床神经外科杂志》2024年第8期453-457,共5页Chinese Journal of Clinical Neurosurgery

基　　金：潍坊市卫健委科研项目(WFWSJK-2022-301)。

摘　　要：目的探讨单纯球囊扩张血管成形术治疗症状性大脑中动脉狭窄的安全性和有效性。方法回顾性分析2020年3月至2022年10月行单纯球囊扩张血管成形术治疗的13例症状性大脑中动脉狭窄的临床资料。结果13例均成功实施手术,球囊扩张成形后责任血管出现夹层并发症4例,其中2例因前向血流良好,给予替罗非班抗血小板聚集治疗,血流稳定,未行支架治疗;2例因责任血管夹层、血流不稳定且血管弹性回缩,给予补救性支架置入术治疗。单纯球囊扩张血管成形术治疗的11例中,1例术后72 h发生非责任血管部位小脑出血,保守治疗好转出院,其余10例未出现严重并发症、恢复良好。11例单纯球囊扩张血管成形术后30 d内未出现责任血管事件;术后90 d NIHSS评分[(2.36±1.57)分]较术前[(3.36±2.38)分]明显降低(P=0.008),mRS评分[(1.55±0.93)分]较术前[(2.27±1.42)分]明显降低(P=0.012);术后6个月颅脑CTA或DSA复查显示血管成形良好。2例给予补救性支架置入术后随访半年未出现脑梗死等事件,NIHSS评分均为3分、mRS评分均为2分,影像学检查未见支架再狭窄情况。结论单纯球囊扩张血管成形术治疗症状性大脑中动脉狭窄手术成功率较高,并发症发生率较低,疗效较好。Objective To explore the safety and efficacy of simple balloon angioplasty for patients with symptomatic middle cerebral artery stenosis.Methods The clinical data of 13 patients with symptomatic middle cerebral artery stenosis treated with simple balloon angioplasty from March 2020 to October 2022 were retrospectively analyzed.Results All 13 patients successfully underwent the surgery.After balloon dilation and angioplasty,dissection in the responsible vessels occurred in 4 patients,of whom 2 patients were treated with tirofiban for antiplatelet aggregation due to good forward blood flow,and the blood flow was stable,and no stent treatment was performed;2 patients received remedial stent implantation due to dissection of the responsible vessel,unstable blood flow and elastic retraction of the vessel.Of the 11 patients treated with simple balloon angioplasty,1 patient had a cerebellar hemorrhage at a non-responsible vessel site 72 hours after the operation,and was discharged after conservative treatment and improvement;the remaining 10 patients had no serious complications and recovered well.No responsible vessel events occurred within 30 days in 11 patients treated with simple balloon angioplasty;the NIHSS score[(2.36±1.57)points]90 days after the operation was significantly lower than that[(3.36±2.38)points]before the operation(P=0.008),and the mRS score[(1.55±0.93)points]was significantly lower than that[(2.27±1.42)points]before the operation(P=0.012);6 months after the operation,the CTA or DSA showed good angioplasty.The 2 patients who received remedial stent implantation had no events such as cerebral infarction during the 6-month follow-up,and the NIHSS scores were both 3 points and the mRS scores were both 2 points,and no restenosis of the stent was observed on imaging reexamination.Conclusion Simple balloon angioplasty has a high success rate of surgery,a low incidence of complications and a good therapeutic effectiveness in the treatment of symptomatic middle cerebral artery stenosis.

关 键 词：症状性大脑中动脉狭窄 球囊扩张血管成形术 安全性 疗效 

分 类 号：R743[医药卫生—神经病学与精神病学] R815.2[医药卫生—临床医学]