药物涂层球囊与自膨式支架治疗症状性大脑中动脉狭窄的安全性与有效性对比研究  

Comparison of safety and efficacy between drug-coated balloon angioplasty and self-expanding stenting in symptomatic middle cerebral artery stenosis

作　　者：徐田明 刘文波 李天晓 何艳艳 丁乾昊 贺迎坤 Xu Tianming;Liu Wenbo;Li Tianxiao;He Yanyan;Ding Qianhao;He Yingkun(Department of Cerebrovascular Diseases,He'nan Provincial People's Hospital(People's Hospital of Zhengzhou University)、He'nan International Joint Laboratory of Cerebrovascular Diseases、He'nan Engineering Research Center of Cerebrovascular Intervention Innovation,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院(郑州大学人民医院)脑血管病科、河南省脑血管病国际联合实验室、河南省脑血管介入创新工程技术研究中心,郑州450003

出　　处：《中华神经医学杂志》2025年第1期23-28,共6页Chinese Journal of Neuromedicine

基　　金：国家卫生健康委能力建设和继续教育项目(GWJJ2023100101);河南省重点研发专项(241111313200);河南省医学科技攻关计划省部共建青年项目(SBGJ202303001)。

摘　　要：目的对比药物涂层球囊(DCB)与自膨式支架成形术治疗症状性大脑中动脉狭窄(MCAS)的效果与安全性。方法回顾性收集河南省人民医院介入中心脑血管病科前瞻性研究数据库中自2020年1月至2022年12月纳入的症状性MCAS患者,按治疗方式将其分为DCB组和支架组。按照1∶1倾向性评分匹配法(PSM)消除2组患者的基线差异,比较2组患者技术成功率、术后即刻再狭窄率、术后6个月再狭窄率及术后30 d内、术后1年内2组患者临床结局。结果PSM后共纳入58例患者,支架组和DCB组各29例。DCB组技术成功率为93.1%(27/29),支架组为96.6%(28/29),差异无统计学意义(P>0.05)。DCB组术后即刻再狭窄率为6.9%(2/29),支架组术后即刻再狭窄率为3.4%(1/29),差异无统计学意义(P>0.05)。2组患者术后30 d内均未出现脑卒中或死亡事件。术后1年内DCB组与支架组责任血管区域缺血性脑卒中发生率分别为3.7%(1/27)、11.5%(3/26),差异无统计学意义(P>0.05);术后1年内2组患者均未发生出血性脑卒中或死亡事件。疗效方面,2组患者随访1年时改良Rankin量表(mRS)评分均为0(0,0)分,差异无统计学意义(P>0.05)。2组共46例患者获得6个月影像学随访,DCB组和支架组再狭窄率分别为8.0%(2/25)、23.8%(5/21),差异无统计学意义(P>0.05)。结论DCB在治疗症状性MCAS方面与自膨式支架的疗效和安全性相当。Objective To compare the efficacy of drug-coated balloon(DCB)angioplasty and self-expanding stenting in symptomatic middle cerebral artery stenosis(MCAS).MethodsA retrospective study was performed.Patients with symptomatic MCAS admitted to Department of Cerebrovascular Diseases,Interventional Center,He'nan Provincial People's Hospital from January 2020 to December 2022 were chosen from their prospective study database.They were divided into a DCB group and a stent group based on approaches.Baseline data differences between the two groups were eliminated using 1:1 propensity score matching(PSM).Then,the technical success rate,immediate restenosis rate,and 6-month restenosis rate,and clinical outcomes within 30 days and 1 year of procedure were compared between the two groups.ResultsAfter PSM,58 patients were included,with 29 in the stent group and 29 in the DCB group.Technical success rate was 93.1%(27/29)in the DCB group and 96.6%(28/29)in the stent group,without significant difference(P>0.05).The immediate restenosis rate was 6.9%(2/29)in the DCB group and 3.4%(1/29)in the stent group,without significant difference(P>0.05).In terms of safety,no stroke or death events were noted in the two groups within 30 days of procedure;ischemic stroke incidence in the offending vessel areas within 1 year of procedure in the DCB group and stent group was 3.7%(1/27)and 11.5%(3/26),without significant difference(P>0.05);no hemorrhagic stroke or death were noted in the two groups within 1 year of procedure.In terms of efficacy,the modified Rankin scale score of the two groups was both 0(0,0)at 1 year of follow-up,without significant difference(P>0.05);46 patients in the DCB group and stent group had imaging followe-up for 6 months:the restenosis rate was 8.0%(2/25)and 23.8%(5/21),respectively,without significant difference(P>0.05).ConclusionDCB angioplasty is comparable in efficacy and safety with self-expanding stenting in symptomatic MCAS.

关 键 词：药物涂层球囊 自膨式支架 大脑中动脉 缺血性脑卒中 

分 类 号：R651.12[医药卫生—外科学]