Wingspan自膨式支架在症状性大脑中动脉狭窄中的应用

目的 探讨Wingspan支架成形术治疗症状性大脑中动脉水平段(M1段)狭窄的安全性和可行性.方法 回顾性分析32例经自膨式支架治疗的症状性大脑中动脉缺血反复发作、药物治疗无效的大脑中动脉狭窄患者的临床资料.本组男19例、女13例,平均年龄(49±19)岁.所有患者经过Gateway球囊预扩后,植入Wingspan自膨式支架.术后6个月对所有患者均进行电话或门诊随访,并建议所有随访患者进行经颅超声多普勒检查或血管造影检查,分析本组患者手术成功率、并发症以及临床疗效.结果 32例患者均成功植入支架,术前M1段狭窄率平均(76.5±15.4)%,支架植入后平均(19.3±9.2)%;球囊预扩引起1例颅内出血、1例M1段急性闭塞,无一例死亡.术后6个月随访无一例患者再发生缺血性神经事件;19例患者在术后6个月行经颅超声多普勒检查,结果显示血流速度正常;5例行血管造影.均显示支架段开通良好,8例患者拒绝影像检查.结论 采用自膨式支架对有症状的M1段狭窄进行成形术可行、安全,近期随访证实疗效确切,但长期疗效还需要进一步观察.

Wingspan stent for symptomatic stenosis of middle cerebral artery

Objective To evaluate the safety and feasibility of Wingspan stent for patients with symptomatic M1 stenosis of middle cerebral artery (MCA). Methods Thirty-two cases with recurrent symptomatic MCA stenosis resistant to medical therapy treated by self-expanding stent were reviewed retrospectively [average (49±19) years old, 13 women]. All patients underwent angioplasty and stenting with the Gateway balloon-Wingspan stent system. After 6 months, all patients were followed up by telephone or clinic, and advised followed up with DSA or TCD. Results Thirty-two patients were successfully stented during the first treatment session. The mean degree of stenosis reduced from (76.5±15.4)% to (19.3±9.2)%. The number of complicating subarachnoid hemorrhage was one, and occlusion occurred on one patients related to balloon angioplasty. During a follow-up of 6 months, there was no recurrence of transient ischemic attack or stroke in 32 available patients. Cerebral hemodynamics using transcranial Doppler monitoring were normal in 19 follow-up patients. Six-month angiographic follow-up was obtained in 5 patients, demonstrating good patency in 5 stenting vessels. The other patients refused to perform TCD or DSA. Conclusions Wingspan stent for symptomatic stenosis of middle cerebral artery appears to be a safe and feasible under strict control of periperformeral project. However further study is needed to evaluate the long-term effect.