摘要
目的评估应用Enterprise支架治疗复杂重度症状性颅内动脉粥样硬化性狭窄(ICAS)的安全性和有效性。方法回顾性分析2012年1月至2018年8月桂林医学院附属医院神经科连续收治的因药物治疗无效而接受Enterprise支架置入治疗的复杂重度症状性ICAS患者42例的临床和影像学资料,分析颅内动脉狭窄形态、技术成功率、围术期并发症、临床及影像随访结果。结果 42例患者中,术前DSA显示椎动脉颅内段狭窄11例,基底动脉狭窄6例,大脑中动脉狭窄21例,颈内动脉颅内段狭窄4例。Enterprise支架置入术成功率为100.0%(42/42),手术后平均狭窄率较术前明显降低[(20±3)%比(82±5)%; t=32.5,P <0.01],后循环的残余狭窄率高于前循环[(24±3)%比(17±3)%; t=2.074,P=0.045]。围术期3例(7.1%)发生并发症,1例大脑中动脉狭窄患者术后因脑出血死亡; 2例术中出现栓子脱落,分别予以药物溶栓和支架治疗后血流恢复通畅。随访(16±2)个月,2例椎动脉V4段术后患者发生支架内再狭窄。结论 Enterprise支架治疗复杂重度症状性ICAS的技术成功率高,治疗相对安全,中短期疗效较好,临床上对于使用Wingspan支架风险较高的患者可选择Enterprise支架作为替代方案。
Objective To evaluate the safety and efficacy of using Enterprise stents for the treatment of complex and severe symptomatic intracranial atherosclerotic stenosis (ICAS). Methods From January 2012 to August 2018,the clinical and imaging data of 42 consecutive patients with complex and severe symptomatic ICAS received Enterprise stenting due to ineffective drug treatment at the Department of Neurology ,the Affiliated Hospital of Guilin Medical University were analyzed retrospectively.The morphology,technical success rate,perioperative complications,clinical and imaging follow-up results of intracranial artery stenosis were analyzed. Results Among 42 patients,preoperative DSA indicated that 11 patients had intracranial vertebral artery stenosis,6 had basilar artery stenosis,21 had middle cerebral artery stenosis,and 4 had intracranial segment stenosis of internal carotid artery.The success rate of Enterprise stenting was 100%(42/42).After operation,the mean stenosis rate was significantly lower than that before operation (20±3% vs.82±5%;t=32.5,P= 0.001),and the residual stenosis rate of posterior circulation was higher than that of anterior circulation (24±3% vs.17±3%;t=2.074,P =0.045).Complications occurred in 3 patients (7.1%) during the perioperative period.One of them with middle cerebral artery stenosis died of cerebral hemorrhage after operation. Two patients had detachment of thrombi during operation,and the blood flow recovered smoothly after drug thrombolysis and stent treatment.During a follow-up period of 16±2 months,the in-stent restenosis occurred in 2 patients after V4 segment operation of vertebral artery. Conclusions The technical success rate of Enterprise stents is high for the treatment of complex and severe symptomatic ICAS.The treatment is relatively safe,and the short-and medium-term efficacy is better.Clinically,patients with higher risk of using Wingspan stents may choose Enterprise stents as an alternative.
作者
邱县生
丁乙夫
夏少怀
李文才
陈力
夏学巍
柯帅
韦家俊
李启明
彭志柱
Qiu Xiansheng;Ding Yifu;Xia Shaohuai;Li Wencai;Chen Li;Xia Xuewei;Ke Shuai;Wei Jiajun;Li Qiming;Peng Zhizhu(Department of Neurosurgery,the Affiliated Hospital of Guilin Medical University ,Guilin 541000,China)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2019年第5期257-262,共6页
Chinese Journal of Cerebrovascular Diseases
基金
国家自然科学基金(81560413)
