症状性颅内动脉硬化狭窄支架成形围手术期并发症分析

目的回顾性分析88例症状性颅内动脉硬化狭窄支架成形治疗围手术期并发症。方法88例患者（男性67例）,平均年龄为66.4±9.0（45～78岁）,大脑中动脉病变28例、颈内动脉颅内段16例、椎动脉颅内段25例、基底动脉19例。结果采用球扩支架组治疗25例（Appolo支架21例,冠脉支架4例）,采用自膨式支架治疗63例。3例因球囊支架无法到位放弃治疗,1例患者拟行Wingspan支架成形因术中导丝穿破分支血管而被迫终止手术,技术成功率95.5%（84/88）。术中3例颅内出血、术后3小时高灌注脑出血颅内出血1例,症状性颅内出血4例,发生率为4.6%（4/88）;症状性缺血性脑卒中3例（2例完全缓解、1例明显改善）,发生率为3.5%（3/88）,围手术期症状性卒中发生率为8.0%（7/88）;严重致残、致死2.3%（2/88）。结论颅内动脉支架成形技术成功率高,围手术期症状性脑卒中的发生率虽较高,但严重致残、致死率较低,是顽固性症状性中重度颅内动脉硬化狭窄的有效、安全的治疗手段。

Complications of stenting for symptomatic intracranial arterial stenosis

Objective To retrospectively analyze the perioperation complications from stenting treatment for symptomatic intracranial arterial stenosis Material and Methods： Eighty-eight patients （mean age 66.42 years; 67 male patients） with symptomatic intracranial atheromatous stenosis （≥70%） were treated with the stent placement. All lesions treated involved the internal carotid artery （n=16）, middle cerebral artery （n=28）, V4 segment vertebral artery（n=25）, basilar artery （n=19）. Result： Three cases with lesions in the anterocirculation failed because of unsuccessful targenting of balloon-mounted stent. And One case failed because of intracranial hemorrhage during the operation. The successful rate of stenting is 95.5% （84/ 88）. Four patients had symptomatic intraranial hemorrhages （ three cases because rupture of the branch during the operation and one case because of postoperation hyperfusion） and the complication rate is 4.6% （4/88）. Three patients had symptomatic ischemic stroke （ two cases with complete remission and one case with great improvment） and the complication rate is 3.5% （3/88）. On the whole, the cerebrovascular complication was 8.0% （7/ 88） during the perioperation period and the severe stroke or mortality is 2.3% （2/88）.Conclusion： Intracranial stenting angiop]sty obviously improved the stenosis with high technical successrate. The cerebralvascular complications are diverse and the rate was relatively high. But it could be accepted because the the severe stroke or mortality was very low. Elective stent placement is a effective and safe treatment for symptomatic intracranial stenosis, especially refractory to medicine.