症状性颅内动脉狭窄支架成形术的有效性及安全性研究

摘要

目的 探讨症状性颅内动脉狭窄患者血管内支架成形术联合药物治疗的有效性和安全性.方法 收集广西脑卒中中心符合支架成形术的症状性颅内动脉狭窄患者共88例,所有入组的患者均行脑血管造影证实颅内动脉狭窄且为责任病变血管,其中行颅内动脉支架成形术联合药物治疗(治疗组)42例,单纯药物治疗(对照组)46例,对两组的治疗结果和终点事件及并发症进行对比分析及随访.结果 入组患者共88例,获得随访86例,1例对照组患者随访1个月后失访,1例对照组患者随访6个月后失访.治疗组入组43例,1例因为血管迂曲导致支架不能到位停止手术,实际入组42例,共置入支架42枚,手术成功率97.7％;围手术期严重并发症3例(7.14％),其中术中发生急性血栓1例,术后脑出血2例,其中1例死亡.两组患者NIHSS评分治疗前以及治疗后1个月差异无统计学意义(P＞0.05),治疗后6个月、12个月、24个月治疗组NIHSS评分低于对照组(P＜0.05).两组患者ADL评分治疗前差异无统计学意义(P＞0.05),治疗后1个月、6个月、12个月、24个月治疗组ADL评分均高于对照组(P＜0.05).6个月、12个月、24个月对照组终点事件发生率较治疗组有增高趋势,但差异无统计学意义(P＞0.05).12个月随访28例治疗组患者复查DSA或CTA,支架内再狭窄6例,再狭窄率21.43％,均无临床症状改变.结论 支架成形术治疗症状性颅内动脉狭窄风险较大,终点事件主要发生在围手术期,但是中远期随访结果显示其术后对神经功能恢复以及改善生活质量有积极作用.%Objective To study the efficacy and safety of endovascular treatment to symptomatic intracranial artery stenosis.Methods 88 patients were collected in stroke center of Guangxi,and all of them were confirmed intracranial artery stenosis after digital subtraction angiography.42 patients were performed intracranial stents and drugs (treatment group),the other 46 patients were performed drugs only (control group).Results 88 patients were collected;one control patient was lost after 1 month follow-up;one control patient was lost after 6 months follow-up.There were three perioperative severe complications in treatment group (7.14％).One of three was experienced acute thrombosis;cerebral hemorrhage was occurred in two patients and one of them died.NIHSS score was not of statistical difference before treatment and 1 month later (P ＞ 0.05),but NIHSS score was statistically different after 6 months,12 months or 24 months in two groups (P ＜ 0.05).ADL score was not statistically different before treatment (P ＞ 0.05),but it was statistically different after 1 month,6 months,12 months or 24 months in two groups (P ＜ 0.05).Endpoints showed an increasing trend after 6 months,12 months and 24 months in control groups.However,it showed no statistical difference (P ＞ 0.05).There were 28 patients performed DSA or CTA in treatment group,and 6 patients had stent restenosis (21.43％).But nobody had clinical symptoms.Conclusion There is risky to endovascular treatment with symptomatic intracranial artery stenosis.Endpoints mainly occur in peri-operation period.It is positive to the recovery of neural function and the quality of life in long-term follow-up,however.