经皮血管内球囊扩张及支架置入术治疗症状性大脑中动脉狭窄

目的：探讨症状性大脑中动脉狭窄的血管内治疗适应证、技术可行性及疗效。方法：回顾性分析自1997年3月至2001年10月收治的经血管内方法治疗的症状性大脑中动脉狭窄14例患者的技术成功率、并发症以及临床疗效，14例患者中9你是2001年以前的病例，单纯采用血管内球囊扩张术，而2001年5例患者全部采取血管内支架成形术。结果：采用球囊扩张的9例患者成功扩张5例，从术前平均狭窄67％扩张到术后的18％，2例由于球囊到位困难而放弃，2例患者出现与技术有关的严重并发症。该5例手术成功的患者，经过平均21个月随访，症状消失2例，所有患者随访期间病情平稳，无卒中发生。5例近期使用冠状动脉支架置入患者，4例成功，术后即刻造影显示狭窄程度从术前的平均85％下降到术后的平均10％，大脑中动脉血流明显增加。1例在支架到位后出现血管破裂。短期随访无卒中再发作（3-5个月）。结论：经皮球囊血管成形术以及支架置入术对于症状性大脑中动脉狭窄的治疗有效，技术可行。支架血管内成形术虽然刚刚起步，更有发展潜力，需要进一步的实践和临床随访。

Percutaneous balloon-angioplasty and intracranial deployment of stents for symptomatic middle cerebral artery stenosis

Objective To discusses the indications, technical feasibility and effectiveness of endovascular treatment for symptomatic MCA stenosis. Methods Fourteen cases with symptomatic MCA stenosis treated by endovascular methods were reviewed respectively. Of the 14 cases, 9 cases were treated only by balloon angioplasty before 2001, and 5 cases were treated using new generation of coronary stent by stent assistant angioplasty. Results 5 of 9 cases using balloon angioplasty were successfully dilated for the mean stenosed segment from 67% to 18% at the instant angiography after procedures. 2 cases had technical failure because of the tortuous vasculature, and 2 cases encountered technical related complication including one elastic recoil and one vessel rupture, the patient with vessel rupture deteriorated and died 4 days after procedure. For 5 cases with stent-assistant angioplasty,successful deployment of the coronary stents were achieved in 4 cases. The mean stenosed segment were dilated from 85% to 10%. The vessel rupture occurred in 1 case after the stent navigated through the narrowed segment. No stroke attacked at a short follow-up period(3-5 months). Conclusion Both single balloon and stent-assistant angioplasty are effective for treatment of symptomatic MCA stenosis, the latter method showed more advantages, but it needs further and long term follow-up study.