术前高分辨率磁共振血管壁成像评估对症状性大脑中动脉狭窄支架成形术的作用

目的探讨术前应用高分辨率磁共振血管壁成像(HRMR-VWI)评估对症状性大脑中动脉M1段狭窄支架成形术的应用价值。方法回顾性分析2011年8月至2019年5月天津市环湖医院神经外科收治的35例症状性大脑中动脉M1段动脉粥样硬化性狭窄患者的临床资料。所有患者均行支架成形术治疗。术前均采用HRMR-VWI评估动脉粥样斑块的位置和稳定性。通过临床随访明确患者术后30 d的病死率、致残率以及术后12个月的缺血性卒中发生情况,采用影像学随访评估再狭窄率。结果35例患者的术前HRMR-VWI评估结果提示,15例斑块位于大脑中动脉M1段腹侧壁,12例位于下壁,8例位于上壁;其中7例大脑中动脉M1段存在不稳定斑块。35例患者均成功置入支架,支架均贴壁良好,血流通畅。2例(5.7%)患者术中出现技术性并发症。术后30 d 1例(2.8%)患者因脑疝死亡,1例(2.8%)患者遗留神经功能障碍。术后12个月,34例患者无一例发生缺血性卒中,获影像学随访的5例患者未见再狭窄发生。结论HRMR-VWI对于评估大脑中动脉狭窄处斑块的位置、稳定性等具有较高的诊断价值,有利于提高支架成形术治疗症状性大脑中动脉M1段狭窄的安全性和有效性。

Application value of preoperative high-resolution magnetic resonance vessel wall imaging evaluation on symptomatic middle cerebral artery stenosis stenting

Objective To investigate the value of preoperative high-resolution magnetic resonance vessel wall imaging(HRMR-VWI)in stenosis stenting for symptomatic middle cerebral artery.Methods The clinical data of 35 patients with atherosclerotic stenosis in middle cerebral artery(MCA)M1 segment who were treated with stenting therapy(stenting angioplasty)at Department of Neurosurgery,Tianjin Huanhu Hospital from August 2011 to May 2019 were analyzed retrospectively.HRMR-VWI results were used to evaluate the location,composition and stability of plaques before operation.The mortality and morbidity at 30 days post operation were determined by clinical follow-up.The ischemic stroke and restenosis rates at 12 months post operation were confirmed by imaging follow-up.Results The preoperative HRMR-VWI of 35 patients showed that the plaques in 15 cases were located on the ventral vessel wall,those in 12 on the inferior,and those in 8 on the upper vessel wall.Seven patients had unstable plaques in the M1 segment of MCA.The stents were successfully placed in 35 patients and well adhered with smooth blood flow.Technical complications occurred in 2(5.7%)patients.One patient(2.8%)died of cerebral hernia due to reperfusion hemorrhage in 30 days after surgery,although decompressive craniectomy and hematoma clearing were performed.One patient(2.8%)had residual neurological dysfunction.Twelve months after the operation,no ischemic stroke occurred in 34 patients,and no restenosis occurred in the 5 patients who were followed up by imaging.Conclusion HRMR-VWI has a high diagnostic value for the location and stability of plaques in stenotic sites of MCA,which could improve the safety and effectiveness of stenting of MCA M1 segment stenosis.