症状性颅内动脉粥样硬化性狭窄支架置入术治疗的长期疗效观察

目的 探讨支架置入术治疗症状性颅内动脉粥样硬化性狭窄(ICAS)的长期安全性及有效性。方法 回顾性研究。纳入2014年9月—2015年8月陆军军医大学第一附属医院神经内科行颅内动脉支架置入术的31例症状性ICAS患者的临床资料,其中男21例、女10例,年龄36~73(57.00±9.87)岁。依据置入支架的类型将患者分为自膨式支架组16例和球扩式支架组15例。对患者进行5年以上随访,观察和记录终点事件:术后30 d内的终点事件包括卒中、短暂性脑缺血发作和死亡,术后30 d~5年的终点事件包括同侧缺血性卒中、出血性卒中、血管性死亡。结果 31例患者获随访1～77(62.7±15.5)个月,5年内发生终点事件4例(死亡3例):术后30 d内发生终点事件(出血性卒中)2例,其中死亡1例;术后30 d~5年的终点事件2例。术后第1~5年每年累积发生终点事件分别为2、2、4、4、4例,其中第3年终点事件增加2例,分别为同侧缺血性卒中1例、出血性卒中1例(均死亡)。自膨式支架组和球扩式支架组患者各项终点事件比较,差异均无统计学意义(P值均＞0.05)。结论 支架置入术治疗症状性ICAS的围手术期及远期观察显示手术方式安全有效。

Long-term efficacy of symptomatic intracranial atherosclerotic stenosis treated with stenting

Objective To investigate the safety and efficacy of stenting for symptomatic intracranial artery stenosis.Methods A retrospective analysis was conducted. Clinical data of 31 patients who underwent intracranial atherosclerotic stent implantation in the Department of Neurology of the First Affiliated Hospital of Army Medical University from September 2014 to August 2015 were included. The patients comprised 21 males and 10 females, aged 36-73 years old (mean, 57.00±9.87 years old). According to the stent type, the patients were divided into the self-expanding stent group (16 cases) and the balloon-mounted stent group (15 cases). Patients were followed up for more than 5 years, and endpoint events were observed and recorded. The endpoint events that occurred within 30 days after stenting events included stroke, transient ischemic attack, and death. The endpoint events that occurred 30 days to 5 years after stenting included ipsilateral ischemic stroke, cerebral hemorrhage, and vascular death.Results Thirty-one patients were followed up for 1-77 months (mean, 62.7±15.5 months). Four patients had endpoint events, including three deaths, within 5 years. Two cases of cerebral hemorrhage had endpoint events within 30 days after surgery, including 1 death. Two patients developed endpoint events in 30 days to 5 years; 2, 2, 4, 4, and 4 cumulative endpoint events occurred in 1 to 5 years, among them, 2 cases were increased in 3 years, 1 was ipsilateral ischemic stroke, and 1 was hemorrhagic stroke; all these patients died. No statistically significant difference was found between the self-expanding stent group and the balloon-mounted stent group for each endpoint event (all P values＞0.05).Conclusions Stenting for symptomatic intracranial arterial stenosis is safe and effective in both perioperative and long-term follow-up periods.