Wingspan支架治疗症状性颅内动脉狭窄的近期和中期疗效观察

摘要

目的 探讨应用Wingspan支架治疗症状性颅内动脉狭窄的近期和中期疗效.分析前、后循环狭窄患者疗效的差异. 方法 纳入药物治疗无效、采用Wingspan支架治疗的症状性颅内动脉狭窄患者87例(前循环组63例,后循环组24例).观察治疗近期及中期治疗效果.结果 ①87例共置入86个Wingspan支架,手术成功率为98.8％.围手术期发生不良事件5例(5.7％).前循环组3例(3/63,4.8％),后循环组2例(2/24,8.3％),差异无统计学意义.②75例通过DSA或电话获得随访(86.2％；前循环组58例,后循环组17例),平均15(12 ～48)个月.随访期6例(6/75,8％)发生缺血事件,卒中、TIA各3例,其中前循环组卒中和TIA各2例,后循环组各1例,两组差异无统计学意义(P＞0.05).③62例(71.3％；前循环组48例,后循环组14例)术后1年行DSA检查.术后1年血管狭窄率为(23±10)％,与术后即刻的(29±10)％比较,差异无统计学意义.其中11例(11/62,17.7％)发生支架内再狭窄,前、后循环组再狭窄发生率分别为18.8％ (9/48)、14.3％(2/14),差异无统计学意义.前、后循环发生再狭窄的患者中,术后残余狭窄率＞术后平均残余狭窄率患者所占的比例均高(7/9,2/2). 结论 Wingspan支架治疗药物治疗无效的症状性颅内动脉狭窄安全有效,但再狭窄率相对较高；前、后循环部位病变治疗效果差异不显著.%Objectives To investigate the short and medium term efficacy in the treatment of symptomatic intracranial artery stenosis using the Wingspan stent system and to analyze the difference of efficacy between the patients with anterior circulation and posterior circulation stenosis.Methods A total of 87 patients with symptomatic intracranial artery stenosis (an anterior circulation group 63 cases,a posterior circulation group 24 cases) who did not respond well to medical treatment and were treated with the Wingspan stent system were enrolled in the study.The short and medium term treatment efficacies were observed.Results ①Of the 87 patients,a total of 86 Wingspan stents were implanted.The success rate of the procedure was 98.8％.Five patients (5.7％) had peri-procedural adverse events.3 were in the anterior circulation (3/63,4.8％) and 2 were in the posterior circulation (2/24,8.3％).There were no significant statistical differences between the 2 groups.②DSA or telephone follow up were available in 75 patients (86.2％,58 in anterior circulation and 17 in posterior circulation),the mean follow up period was 15 months (range 12 to 48 months).During the follow-up period,6 patients (6/75,8％) had ischemic events,3 had stroke and 3 had TIA.Among them,2 had stroke and 2 had TIA in the anterior circulation group,1 had stroke and 1 had TIA in the posterior circulation group.There were no significant differences between the 2 groups (P ＞ 0.05).③One year after procedure,62 patients (71.3％,48 in anterior circulation and 14 in posterior circulation) underwent DSA examination.The residual stenosis rate at 1 year after procedure was (23 ± 10)％,compared to (29 ± 10)％ immediately after procedure,there was no significant difference.Eleven patients (11/62,17.7％) occurred in-stent restenosis.The incidences of restenosis in the anterior and posterior circulation groups were 18.8％ (9/48) and 14.3 ％ (2/14) respectively.There was no significant difference.Of the patients with anterior and posterior circulation restenosis,the proportions of the patients with postoperative residual stenosis rate ＞ the mean immediate postoperative stenosis rate were higher (7/9 vs.2/2).Conclusion Wingspan stents in the treatment of drug-refractory symptomatic intracranial arterial stenosis is safe and effective,but the restenosis rate is relatively high.The treatment efficacy of the anterior circulation and posterior circulation lesions has no significant difference.