症状性大脑中动脉狭窄的血管内干预治疗

目的 探讨经皮腔内血管成形术及血管成形支架置入术治疗症状性大脑中动脉狭窄的可行性、安全性及有效性.方法 回顾性分析39例患者经药物治疗无效、反复短暂性脑缺血发作(TIA)或有明显脑缺血症状的大脑中动脉狭窄,经皮腔内血管成形或支架置入术的治疗及术后随访结果.结果 39例大脑中动脉狭窄(左侧23例,右侧13例,双侧3例,合并颈动脉狭窄5例)患者经皮腔内血管成形术9例、血管成形支架置入术30例(术后残余狭窄程度均<10%)均获成功,术后给予抗血小板聚集治疗,临床脑缺血症状和体征明显改善.2例患者术中见对比剂外泄,但无明显临床症状,且恢复良好;1例在术后1 h出现意识变化、对侧肢体活动障碍,CT提示支架侧底节区脑出血,经手术治疗后患者遗留语言障碍及右侧肢体不全偏瘫.其余患者无并发症发生.临床随访5～60个月,仅1例在支架置入7个月后右上肢无力症状复发,但较前轻微.经颅多普勒复查26例,显示原病变侧大脑中动脉血流速度增快2例;行数字减影血管造影复查14例,2例支架内发生再狭窄,均行药物治疗观察.结论 经皮腔内血管成形术及血管成形支架置入术治疗大脑中动脉狭窄是可行、安全、有效的;大样本的长期疗效有待于进一步观察.

Endovascular interventional treatment for symptomatic stenosis of middle cerebral artery

Objective To study the feasibility, security and validity of pereutaneous angioplasty (PTA) or percutaneous angioplasty and stentiag(PTAS) for symptomatic stenosis of middle cerebral artery. Methods The results of treatment and follow-up of 39 cases with symptomatic atenosis of middle cerebral artery who had either recurrent transient ischemic attacks (TIAs) or resistant to medical therapy and were performed PTA or PTAS were studied retrospectively. Results Among the 39 cases with stenosis of middle cerebral artery (23 in left,13 in right, 3 in bilateral side and 5 cases combining with stenosis of carotid artery) PTA were successfully performed in 9 cases and PTAS in 30 (whose post-operative residual stenosis were less than 10%). After operation the patients were administrated with antiplatelet drugs. The clinic symptom and sign of ischemia were improved obviously after operation. During the procedure the contrast could be seen outside the vessel in 2 cases, the patients had no obvious symptom of hemorrhage and got well rapidly. But in another case her conciousness changed 1 h after PTAS and the limbs could not move in right side. Emergency CT scan showed cerebral hemorrhage in left basic node area. The patient suffered language barrier and incomplete bemiplegy in right side. No complication was occurred in the others. During 5 to 60 months follow-up, the symptom of weakness in right arm reoccured but lighter than before in only one case.TCD rechecked in 26 cases and demonstrated the blood beem speed was faster than normal in two case. DSA rechecked in 14 cases showed restenosis in-stent in the 2 cases and they were treated by medicine. Conclusions PTA and PTAS is a feasible, safe and effective therapeutic method for the patients with symptomatic stenosis of middle cerebral artery. Further study in large number of patients is needed for long-term outcome.