单纯球囊亚满意扩张治疗后循环进展性卒中伴基底动脉极重度狭窄的效果分析

目的 评估应用单纯小球囊亚满意扩张治疗后循环进展性卒中伴基底动脉极重度狭窄的安全性及有效性.方法 回顾性分析战略支援部队特色医学中心2017年1月至2019年1月采用小球囊(Gateway 1.5 mm×9.0 mm或2.0 mm×9.0 mm)亚满意扩张治疗后循环进展性卒中并基底动脉极重度狭窄患者6例的临床及影像学资料.分析患者起病及进展后的美国国立卫生研究院卒中量表(NIHSS)评分、狭窄血管直径、狭窄病变的分型、技术成功率、围手术期并发症、影像及临床随访结果等.结果 6例患者发病后短时间内,症状均有不同程度的进展.狭窄病变Mori分型A型4例,B型2例.狭窄病变术前残余管腔直径(0.15±0.05)mm,狭窄程度平均(93±3)%.采用小球囊亚满意扩张后,狭窄病变残余管腔直径(1.03±0.21)mm,残余狭窄程度平均(50±10)%,与术前比较,差异均有统计学意义(t值分别为11.79、11.74,均P<0.01).围手术期并发症1例,为穿支脑梗死事件,经康复治疗后,症状逐渐改善.临床随访11~23个月,改良Rankin量表(mRS)评分≤2分5例,mRS评分3分1例.结论 对于伴有基底动脉极重度狭窄的后循环进展性卒中应积极进行干预,单纯小球囊亚满意扩张的技术成功率高,围手术期并发症较少,中短期疗效较好,是治疗该类疾病的可选方案.

Effect of submaximal primary angioplasty for progressive ischemic stroke of posterior circulation coexisting with severe basilar artery stenosis

Objective To evaluate the safety and efficacy of submaximal primary angioplasty for the progressive ischemic stroke of posterior circulation combined with severe basilar artery stenosis.Methods The datas of patients with progressive ischemic stroke of posterior circulation combined with severe basilar artery stenosis in the Strategic Support Force Medical Center of People′s Liberation Army were retrospectively analyzed from January 2017 to January 2019.All patients were treated with submaximal angioplasty(Gateway 1.5 mm×9.0 mm/2.0 mm×9.0 mm).The clinical and angiographic data were collected,including the National Institute of Health stroke scale(NIHSS)scores at the time of onset and deterioration,the types of stenosis lesions,technical success rate,periprocedural complications,and angiographic and clinical follow up.Results A total of six patients eligible were enrolled.Based on the lesion′s morphology,4cases of basilar artery stenosis were classified as Mori type A,and 2 were classified as Mori type B.The residual diameter and degree of the stenosis were(0.15±0.05)mm and 93%±3%before the treatment,respectively.After the treatment with submaximal primary angioplasty using Gateway balloon,the residual diameter and degree of the stenosis were(1.03±0.21)mm and 50%±10%,respectively,which were both statistically significant compared to those before the procedures(t=11.79 and 11.74,respectively,all P<0.01).The time of clinical follow up was between 11 and 23 months for all patients.One patient suffered from perforating cerebral arterial infarction during the periprocedural period,and his symptoms remitted gradually after rehabilitation therapy.Five patients had a good outcome(modified Rankin scale score≤2).Conclusion Progressive ischemic stroke of posterior circulation coexisting with severe basilar artery stenosis should be aggressively treated with submaximal primary angioplasty due to it has a high rate of technical success,a relatively low rate of periprocedural complications and good early and mid term outcomes.