摘要
目的评估在高分辨率磁共振成像(HR-MRI)指导下应用血管腔内成形术开通症状性非急性期闭塞颅内大动脉的可行性、安全性和临床疗效。方法回顾性分析2017年6月至2019年12月大连医科大学附属第一医院介入治疗科连续收治的症状性颅内大动脉亚急性及慢性闭塞患者31例的临床资料,全部患者使用HR-MRI对闭塞段管腔和斑块位置进行评估,明确闭塞性质(血栓或管壁实质性闭塞),获取颅内动脉斑块分布以及与穿支动脉开口位置之间的关系。根据评估结果筛选出26例患者,采用血管腔内成形术进行再通治疗,评价手术技术成功率、围手术期并发症及术后临床和影像学的随访效果,采用改良Rankin量表(mRS)评估患者的预后。结果 26例手术患者中,22例闭塞血管成功开通;4例开通失败,其中1例为颈内动脉C6段闭塞,2例为椎动脉颅内段闭塞,1例为基底动脉闭塞,术中均因导丝难以通过闭塞段而终止手术。术中发生并发症2例,均为无症状性末梢栓塞事件,无围手术期出血并发症及死亡患者。22例成功开通患者中位随访时间12(3,21)个月,无死亡及失访病例,中位mRS评分为1(1,3),无新发卒中及短暂性脑缺血发作;2例发生无症状性支架再狭窄,无不良反应及不良后果发生。4例手术失败患者中位随访时间11(3,18)个月,无死亡及失访患者,中位mRS评分为2(2,3),1例新发卒中,2例发生短暂性脑缺血发作。结论对于非急性期症状性颅内大动脉闭塞患者,经过HR-MRI对闭塞段的闭塞长度、病变性质和潜在腔隙等进行评价,结合其他临床情况,筛选合适病例,实施血管腔内成形术治疗安全可行,短期内能够改善患者的缺血症状,降低再发卒中率,远期疗效尚需长期随访证实。
Objective To evaluate the feasibility, safety and clinical efficacy of endovascular angioplasty for symptomatic, non-acute occlusion of the large intracranial artery under the guidance of high-resolution magnetic resonance imaging(HR-MRI). Methods A total of 31 patients with symptomatic and subacute or chronic occlusion of the large intracranial artery in the Department of Interventional Therapy, First Affiliated Hospital of Dalian Medical University from June 2017 to December 2019 was analyzed retrospectively. The location of luminal and plaque at the occlusion segment were evaluated by HR-MRI to determine the characteristic of the occlusion(thrombosis or substantial occlusion of the wall), and obtain the relationship between the plaque distribution of intracranial artery and the opening location of perforating artery. According to the evaluation results, 26 patients were screened for recanalization with angioplasty. The success rate of surgical technique, perioperative complications, and the outcomes of postoperative clinical and imaging follow-up were evaluated. The modified Rankin scale(mRS) was used to assess the patient′s prognosis. Results Of the 26 patients undergoing surgery, 22 cases were successful in recanalizing the occlusion vessel;4 cases were failed to open due to the guidewire was difficult to pass through the occlusion segment, of which one case was occluded at the C6 segment of the internal carotid artery, two cases were occluded at the segment of the intracranial vertebral artery, and one case was occluded at the basilar artery. There were 2 cases with complications during the operation, both of which were asymptomatic peripheral embolism, and there were no complications of bleeding and death during the perioperative period. The median follow-up time in 22 successful patients was 12(3, 21) months. There were no deaths or losses to follow-up. The median mRS score was 1(1, 3). There were no recurrent stroke or transient ischemic attacks. Two cases of asymptomatic in-stent restenosis occurred w
作者
王铭义
刘永晟
徐放
李克
刘勇建
张国栋
吴邯
王峰
安祥博
Wang Mingyi;Liu Yongsheng;Xu Fang;Li ke;Liu Yongjian;Zhang Guodong;Wu Han;Wang Feng;An Xiangbo(Department of Intervention therapy,First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2020年第5期259-265,271,共8页
Chinese Journal of Cerebrovascular Diseases
关键词
颅内动脉闭塞性疾病
高分辨率核磁共振
血管腔内成形术
Intracranial arterial occlusive disease
High resolution magnetic resonance imaging
Angioplasty
