Fastunnel球囊与Gateway球囊在大脑中动脉M1段动脉粥样硬化性狭窄中应用效果的对比研究  

A comparative study of Fastunnel and Gateway balloons in the treatment of atherosclerotic stenosis in the M1 segment of the middle cerebral artery

作　　者：马骥[1] 史帅龙 时程程 田奇 龙树海 杨杰[1] 王晔[1] 陈振[2] 郭栋[1] 李治国[1] 李腾飞[1] Ma Ji;Shi Shuailong;Shi Chengcheng;Tian Qi;Long Shuhai;Yang Jie;Wang Ye;Chen Zhen;Guo Dong;Li Zhiguo;Li Tengfei(Department of Interventional Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Neurointervention,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院放射介入科,郑州450052 [2]郑州大学第一附属医院神经介入科,郑州450052

出　　处：《中华神经外科杂志》2025年第3期268-274,共7页Chinese Journal of Neurosurgery

基　　金：河南省中青年卫生健康科技创新杰出青年人才培养项目(YXKC2022029);河南省高等学校重点科研项目(24A320038);河南省科技攻关项目(242102310109)。

摘　　要：目的对比分析Fastunnel球囊与Gateway球囊扩张联合颅内支架置入在大脑中动脉M1段动脉粥样硬化性狭窄(AS)治疗中的安全性和有效性。方法回顾性分析2023年6月至2024年2月郑州大学第一附属医院放射介入科75例使用Fastunnel或Gateway球囊联合颅内支架治疗大脑中动脉M1段AS患者的临床和影像学资料,依据术中使用球囊的不同分为Fastunnel组(34例)和Gateway组(41例)。统计两组的球囊导管扩张压力、次数,通过数字减影血管造影(DSA)分析术前血管狭窄率、球囊扩张后及支架置入后的血管残余狭窄率;同时观察和记录手术并发症;采用改良Rankin量表(mRS)评分评价术后患者神经功能情况;术后3~6个月,采用DSA或CT血管成像(CTA)评估支架内血流通畅情况。结果Gateway组患者球囊扩张及后续颅内支架置入成功率达100%(41/41),Fastunnel组为94.1%(32/34),差异无统计学意义(P=0.202)。但Fastunnel组有2例支架到位困难,1例经导管调整后成功释放,但术后显示支架头端标记点打折;另1例推送支架失败,换用支架匹配微导管完成释放。血管狭窄率方面,术前Gateway组和Fastunnel组分别为(78.32±10.15)%、(79.87±10.55)%,球囊扩张后分别为(17.40±6.92)%、(17.24±6.48)%,支架置入后分别为(14.20±5.71)%、(13.54±5.12)%,各阶段两组血管狭窄率差异均无统计学意义(均P>0.05)。并发症方面,75例患者中,17例(Gateway组7例、Fastunnel组10例)术中出现局部轻微血管夹层,支架置入后夹层消失;两组均未在围手术期出现血管破裂出血、远端血管栓塞等严重并发症,且两组患者出现轻微并发症的差异无统计学意义(P=0.204)。75例患者术后随访时间为(6.49±1.99)个月(3~10个月)。至末次随访,两组患者的mRS评分差异无统计学意义(P=1.000)。71例(Gateway组39例、Fastunnel组32例)患者在术后3~6个月完成影像学复查(56例DSA、15例CTA);其中4例(Gateway组3例、Fastunnel组1例)出现支架�ObjectiveTo compare and analyze the safety and efficacy of Fastunnel balloon versus Gateway balloon dilatation combined with intracranial stent implantation in the treatment of atherosclerotic stenosis(AS)in the M1 segment of the middle cerebral artery.MethodsThis retrospective study analyzed clinical and imaging data from 75 patients who underwent treatment for AS in the M1 segment of the middle cerebral artery using either Fastunnel or Gateway balloons combined with intracranial stent implantation at the Department of Interventional Radiology,the First Affiliated Hospital of Zhengzhou University from June 2023 to February 2024.Patients were divided into two groups based on the balloon brand used:the Fastunnel balloon group(34 patients)and the Gateway balloon group(41 patients).Balloon dilation pressures and number of balloon inflations were compared between the two groups.Preoperative stenosis rates,post-balloon dilation stenosis rates,and post-stent implantation residual stenosis rates were analyzed using by digital subtraction angiography(DSA).The operative complications were observed and recorded.The modified Rankin scale(mRS)was used to evaluate the neurological function of the patients after operation,and DSA and CT angiography(CTA)were used to evaluate the patency of blood flow in the stent follow-up at 3–6 months post surgery.ResultsRegarding technical success,the Gateway balloon group had a 100%(41/41)one-time success rate for balloon dilation and subsequent intracranial stent implantation,while the Fastunnel group had a success rate of 94.1%(32/34),and there was no statistically significant difference between the two groups(P=0.202).However,in the Fastunnel group,there were 2 cases of stent delivery failure.In one case,the stent was successfully deployed after catheter deflation and adjustment,but showed a distortion at the proximal marker.In another case,multiple stent delivery attempts failed,and stent release was successful only after switching to a compatible microcatheter.Regarding vessel stenos

关 键 词：大脑中动脉 动脉粥样硬化 支架 血管成形术 Fastunnel球囊 并发症 

分 类 号：R743[医药卫生—神经病学与精神病学]