自膨胀式支架置入术治疗颅内动脉粥样硬化性狭窄术后再狭窄危险因素分析  

Analysis of Adverse Events and Risk Factors of Restenosis after Self-expandable Stent Implantation for Intracranial Atherosclerotic Stenosis

作　　者：张勇 吕鸿燕 李苇 潘迎生 丛光燕 ZHANG Yong;LÜHong-yan;LI Wei;PAN Ying-sheng;CONG Guang-yan(Department of Neurology,Luan People’s Hospital,Luan 237005,China)

机构地区：[1]安徽省六安市人民医院神经内科,六安市237005

出　　处：《中国临床神经科学》2024年第6期656-662,704,共8页Chinese Journal of Clinical Neurosciences

摘　　要：目的探讨Enterprise自膨胀式支架置入术治疗症状性颅内动脉粥样硬化性狭窄(ICAS)的疗效和安全性。方法共纳入155例ICAS患者,采集患者基线资料、实验室检查及术前影像学结果。所有患者均顺利完成Enterprise自膨胀式支架置入术,观察术中即刻支架移位及血栓形成发生情况;记录患者术后30 d内有无发生手术相关性脑卒中,包括蛛网膜下腔出血(SAH)、脑实质出血及缺血性脑卒中、短暂性脑缺血发作(TIA)和(或)死亡,等。通过门诊复诊和(或)电话访问进行随访,包括有无发生缺血性脑卒中、TIA和(或)死亡,并在术后6个月时行影像学复查。采用单因素和多因素Logistic回归模型探讨患者基线数据、颅内动脉狭窄特征与手术指标对安全性结局及支架内再狭窄风险的影响。结果155例患者中,男性105例、女性50例;年龄38.4~82.1岁;术前狭窄率72.3%~95.4%,狭窄长度2.7~28.6 mm。术后30 d内出现手术相关脑卒中16例(10.3%),其中出血性脑卒中9例(SAH 5例,脑实质出血4例)、缺血性脑卒中7例(穿支动脉闭塞6例,支架内血栓形成1例)。中位随访时间为8.9[6.8,13.6]个月。随访过程中,发生与手术相关的责任区域缺血事件13/155例(8.4%),其中TIA 7例,缺血性脑卒中6例;21/155例(13.5%)出现支架内再狭窄,其中12例有症状;术后30 d内及随访期间均无死亡病例。结论Enterprise自膨胀式支架植入术治疗症状性ICAS安全、有效,未发现与手术相关并发症的独立危险因素,术后动脉狭窄残余程度与支架内再狭窄呈显著正相关,未来尚需更长时间的随访和更多随机对照研究以确认上述结果。Aim To investigate the efficacy and safety of Enterprise self-expanding stent implantation in the treatment of symptomatic intracranial atherosclerotic stenosis(ICAS).Methods A total of 155 patients were included in this study,and baseline data,laboratory examinations,and preoperative imaging results were collected.All patients were successfully completed the self-expandable stent implantation surgery.Stent displacement and thrombosis were observed immediately during the operation.The incidence of surgical related stroke[including subarachnoid hemorrhage(SAH),parenchymal hemorrhage and ischemic stroke,etc.],transient ischemic attack(TIA)and/or death were recorded within 30 days after surgery.Follow-up was conducted by outpatient visit and/or telephone interview[including absence of ischemic stroke,TIA,and/or death],and imaging review was performed at 6 months after surgery.The effects of patient baseline data,intracranial artery stenosis characteristics,and surgical indicators on safety outcomes and intrastent stenosis(ISR)were explored by using single factor and multivariate Logistic regression models.Results Among the 155 patients,105 were males(67.7%)and 50 were females(32.3%).The age range is 38.4-82.1 years old,with of median[57.8(52.3,63.1)]years old.The preoperative stenosis rate range is 72.3%-95.4%,and the stenosis length range is 2.7-28.6 mm.Within 30 days after surgery,there were 16 cases(10.3%)of surgical related stroke,including 9 cases of hemorrhagic stroke[5 cases(3.2%)of subarachnoid hemorrhage,4 cases(2.6%)of cerebral parenchymal hemorrhage],7 cases(3.9%)of ischemic stroke[6 cases of perforating artery occlusion,and 1 case(0.6%)of stent thrombosis].During the median follow-up period of[8.9(6.8,13.6)]months,there were 13 cases(8.4%)of surgical related ischemic events in the responsible area,including 7 cases(4.5%)of transient ischemic attacks and 6 cases(3.9%)of ischemic stroke.A total of 21 cases(13.5%)developed ISR,of which 12 cases(7.7%)had symptoms,and no deaths occurred within 30 days after s

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 并发症 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]