症状性颅内动脉粥样硬化性狭窄支架成形术的体会及分析

目的评价症状性颅内动脉狭窄支架成形术的可行性、安全性和操作技术。方法对53例症状性颅内动脉狭窄患者(53处支架)进行回顾性分析。结果 1支架成功率94.3%,操作相关并发症9.4%(5/53),围手术期症状性卒中发生率9.4%(5/53),严重致残、致死率1.9%(1/53);2术后定期随访,症状性卒中的发生率7.5%(4/53);结论颅内动脉支架成形术成功率高,但操作相关并发症、围手术期症状性卒中的发生率较高,为减少卒中并发症,需要严格的术前准备及围手术期措施,其长期疗效有待进一步观察。     

12例椎-基底动脉串联病变的血管内治疗探讨

目的探讨经皮血管内支架成形术(PTAS)治疗椎-基底动脉重度狭窄串联病变的有效性、安全性及可行性。方法对12例(26处)经药物治疗无效的症状性椎-基底动脉串联病变患者采用经皮血管内支架成形术治疗。术前DSA示动脉直径狭窄率为65～100%,平均84.62±8.24%。结果本组支架置放成功率92.6%,术后平均狭窄率为16.92±14.84%;术后用mRS量表(改良RANKIN量表)评分,7例0分,3例1分,2例3分。发生2例围手术期并发症,年卒中率为6.2%;随访期间2例发生支架内再狭窄。结论血管内支架成形术治疗椎-基底动脉串联病变,在技术上可行,远期疗效良好。     

症状性颅内动脉狭窄支架成形术

目的　研究支架成形术治疗症状性颅内动脉狭窄的可行性和安全性。方法　155例症状性颅内动脉狭窄病人(170处病变 )接受了支架成形术。结果　支架成功率 92. 4% ( 157 /170 ),操作相关并发症率 11.8% ( 20 /170 ), 30d的卒中和死亡率 6. 5% ( 10 /155例 )。临床随访 150例(443d± 271 3d), 30d后的卒中和死亡率为 2 0% (2 /150)。造影随访 44例、49条支架血管,再狭窄率 16% (8 /49)。结论　支架成形术是治疗症状性颅内动脉狭窄可行的方法,但有较高的并发症。为了减少卒中与死亡,需要严格的手术和围手术期措施。尚需进行随机对照研究。     

颈动脉支架成形术治疗颅外段颈动脉夹层的疗效观察

目的 评价颈动脉支架成形术治疗颅外段颈动脉夹层的有效性及安全性。方法 选择颅外段颈动脉夹层患者9例,均行颈动脉支架成形术,观察术后血管狭窄及夹层动脉瘤改善情况,围术期并发症的发生情况,对患者随访3个月到1年。结果 手术技术成功率为100%,术后平均残余狭窄率均≤30%,患者颈动脉平均狭窄程度从(75.0±17.6)%降低至(15.8±9.2)%,夹层动脉瘤均消失,支架置入手术前后比较,差异有统计学意义(P<0.05)。患者术后缺血相关症状均有明显改善,围术期所有患者均未出现症状性脑卒中,无手术相关死亡事件发生,随访无缺血性脑血管事件发生,1例患者可见支架内再狭窄。结论 颈动脉支架成形术治疗颅外段颈动脉夹层安全、有效。     

国产雷帕霉素洗脱支架治疗椎动脉狭窄的短期疗效及安全性

目的评价国产雷帕霉素洗脱支架治疗椎动脉狭窄短期的安全性及有效性。方法选取50例椎动脉狭窄或闭塞患者,采用国产雷帕霉素洗脱支架行支架成形术,观察手术成功率及并发症发生情况。结果 50例均顺利完成手术,手术成功率100%;支架成形术后血管残余狭窄程度0～20%,平均1.9%,围手术期并发症发生率为2%(1/50);短期随访再狭窄率4%(2/50)。结论国产雷帕霉素洗脱支架在椎动脉狭窄中应用安全、有效,值得推广。     

球囊扩张术治疗症状性颅内动脉狭窄安全性分析

目的探讨单纯球囊扩张术治疗症状性颅内动脉狭窄围手术期疗效及安全性。方法回顾分析2016年5月至2019年5月采用单纯球囊扩张术治疗的28例症状性颅内动脉重度狭窄患者的临床、实验室、影像学及随访资料,并评价术后手术成功率、术后并发症、改良Rankin量表(mRS)评分和随访情况。结果 28例患者中共有26例成功完成球囊扩张术,手术成功率为92.86%,术后即刻狭窄远端改良脑梗死溶栓血流分级均≥2b级;另外2例应用支架成形术。28例患者术后及随访30 d均未出现临床症状加重的相关并发症。术后30d 10例患者mRS评分为1分,其余18例患者mRS评分为0分。结论单纯球囊扩张术治疗症状性颅内动脉狭窄围手术期相对安全,支架成形术是球囊扩张术效果欠佳时的一种方法。     

症状性颅内动脉狭窄的支架治疗

目的探讨Wingspan支架治疗症状性颅内动脉狭窄的安全性、可行性和临床疗效。方法应用Wingspan支架治疗90例症状性颅内动脉狭窄患者,观察其手术技术成功率、围手术期并发症,以及术后6个月时脑血管造影显示的支架内再狭窄率。结果 90例患者手术技术成功率约为98.92%(92/93)。术前平均狭窄率为(83.42±9.53)%,术后残余狭窄率为(21.82±9.86)%,手术前后比较差异具有统计学意义(t=3.280,P=0.002)。共5例发生围手术期并发症,约占5.56%(5/90),3例死亡;术后6个月时再狭窄发生率约为19.10%(17/89)。结论 Wingspan支架植入术治疗症状性颅内动脉狭窄具有较高的手术技术成功率、较低的手术并发症及较好的近期疗效,尚待进一步观察患者远期疗效。     

Apollo球囊扩张式支架治疗症状性颅内动脉狭窄的临床研究

目的探讨Apollo支架治疗症状性颅内动脉狭窄的安全性及临床疗效。方法采用Apollo支架植入治疗22例(24支)症状性颅内动脉狭窄患者,随访3～28个月,平均14个月,分别观察技术成功率和围手术期并发症、手术前后神经功能缺损程度、随访期间支架内再狭窄发生情况,以及脑卒中复发率和病死率。结果 Apollo支架植入治疗症状性颅内动脉狭窄的技术成功率为91.67%(22/24),平均狭窄率由手术前(73.23±9.59)%降至手术后(4.12±9.17)%(t=3.325,P=0.005)。围手术期未发生手术相关并发症,手术后神经功能缺损程度显著改善[美国国立卫生研究院卒中量表(NIHSS)评分:(0.59±1.35)比(0.59±1.74);t=2.718,P=0.015]。临床随访无脑卒中复发或死亡病例,CTA随访无支架内再狭窄。结论 Apollo支架植入治疗症状性颅内动脉狭窄可行且安全有效。     

腔内支架成形术治疗症状性颅内动脉狭窄11例

目的探讨腔内支架成形术治疗症状性颅内动脉狭窄的临床效果和安全性。方法2006年7月至2008年12月,应用腔内支架成形术治疗症状性颅内动脉狭窄患者11例,其中置入冠脉球扩式支架9枚,Wingspan支架2枚。结果11例患者颅内动脉动脉狭窄程度由原来的76.55%±4.94%下降至3.73%±0.98%,两者相差显著（P〈0.01）。术后10例患者症状均明显改善,围手术期无并发症。随访2~12个月,11例均无短暂性脑缺血发作;经颅多普勒超声检查显示,原狭窄血管近端、远端血流速度和支架置入后24h无明显差别。结论腔内支架成形术是治疗症状性颅内动脉狭窄的安全、有效的方法,临床效果好。适应证的正确选择和围手术期的专业处理以及娴熟的操作技巧是手术成功的关键,但其远期疗效还需要长期随访观察。     

Wingspan支架治疗症状性椎动脉颅内段和基底动脉狭窄的临床观察

目的 评估Gateway-Wingspan支架治疗症状性椎动脉颅内段和基底动脉狭窄患者的安全性和有效性.方法 回顾性分析应用Gateway-Wingspan支架治疗39例症状性椎动脉颅内段和基底动脉狭窄患者的临床资料,观察围手术期情况及术后随访情况.结果 39例患者共40处狭窄行血管内支架成形术,其中椎动脉颅内段9处,基底动脉31处.1例患者因支架到位困难,仅行球囊扩张.共成功置入Wingspan支架39枚,手术成功率98％ (39/40).术前平均狭窄率为(78.09±12.01)％,术后残留狭窄率为(16.53±12.59)％.4例发生围手术期并发症,发生率为10％(4/39),其中1例死亡,其余患者临床症状均有所好转.随访8-42个月,平均(25.0±10.8)个月,有2例出现症状性再狭窄(狭窄程度＞50％),其中1例是支架置入失败的患者.1例因肺部感染死亡.结论 应用Gateway-Wingspan支架治疗椎动脉颅内段及基底动脉狭窄是安全有效的,长期疗效需进一步观察.     

Endovascular treatment of symptomatic intracranial atherosclerotic stenosis with low profile visualized intraluminal support stent

ObjectiveSevere intracranial atherosclerotic stenosis has become one of the main causes resulting transient ischemic attack and stroke. This study aimed to evaluate the efficacy and safety of low profile visualized intraluminal support (LVIS) stent in treating symptomatic intracranial atherosclerotic stenosis.MethodsData of 31 patients with at least 70% stenosis treated with LVIS stent in our center were retrospectively collected between July 2017 and November 2020. Further evaluation of lesion characteristics, technical success rate, preoperative complication, clinical and angiographic follow-up outcome, delayed in-stent stenosis were conducted.ResultsStent delivery and deployment were successfully achieved in all 31 patients (100%). 22 cases (71%) were located in anterior circulation and 9 cases (29%) were located in posterior circulation. The mean degree of stenosis lesion before stent deployment was 85.6 ± 9.4%, while after stenting was 11.2 ± 11.8%. One patient suffered from ischemic complication in stenting procedure, and timely delivery of rt-PA successfully recanalized the artery. Clinical follow-up was available in all 31patients (100%) with mean follow-up time 15.0 ± 12.1(3–45) months. No patients experienced the recurrence of stroke or TIA or death after discharge. Angiographic follow-up was available in 21patients (67.7%) with mean follow-up time 11.43 ± 6.8 (6–36) months. 19 patients (90.5%) were stable while 2 patients (9.5%) developed ISR in their last angiographic follow-up. The 2 patients received balloon angioplasty and reached satisfactory results after retreatment.ConclusionThis preliminary study suggests that LVIS stent deployment was a feasible approach in treating intracranial atherosclerotic stenosis with satisfactory procedure success rate, low complication rate and favorable long-term outcome.     

不同类型支架的血管成形术治疗颅内动脉狭窄对比研究

目的 分析不同支架类型对血管成形术治疗症状性颅内动脉狭窄的安全性、疗效与再狭窄的影响.方法 对采用支架成形术治疗的264例症状性颅内动脉狭窄患者进行回顾性分析,分析球扩会属裸支架、药物洗脱支架和白膨胀支架系统的手术成功率、临床终点事件及再狭窄率.结果 球扩金属裸支架组(128处)、药物洗脱支架组(114处)和自膨胀支架治疗组(45处)的手术成功率分别为95.3%、97.3%和97.8%.12个月内累积终点事件发生率分别为4.8%、6.5%和6.0%.在随访3-48个月(平均18.6个月)中支架内再狭窄的发生率分别为28.5%、4.8%和0%.结论 支架成形术治疗症状性颅内动脉狭窄技术上是安全可行的.使用支架的类型对手术成功率和临床终点事件无影响.     

Wingspan支架治疗国人症状性颅内动脉狭窄的初步经验

目的 研究颅内专用自膨式支架系统 (Wingspan支架)联合Gateway球囊治疗国人症状性颅内动脉狭窄的可行性。方法 10例症状性颅内动脉狭窄患者（12处病变）接受了Wingspan支架联合Gateway球囊治疗，前瞻性收集所有患者的临床及影像学资料，临床随访观察30 d。结果 12处靶病变分别位于大脑中动脉（n＝6）、颅内颈内动脉（n＝4）、颅内椎基底动脉（n＝2），支架成功率91.7%（11/12)，手术成功率90.0％（9/10），治疗前平均狭窄率为71.4％，球囊扩张后改善为33.3％，支架成形术后改善为20.0％。所有病变均使用了Gateway球囊扩张，1例基底动脉狭窄Wingspan支架到达靶病变部位后未能成功释放；围手术期30 d内，1例患者术后发生1次短暂性脑缺血发作（TIA），其余患者均未发生手术相关并发症。结论 采用Wingspan支架联合Gateway球囊治疗国人颅内动脉狭窄技术上是可行的，长期疗效还需要更大量病例样本及更长时间的病例随访数据。     

Apollo球囊扩张式支架治疗症状性颅内动脉狭窄的临床研究

目的探讨Apolio支架治疗症状性颅内动脉狭窄的安全性及临床疗效。方法采用Apollo支架植入治疗22例（24支）症状性颅内动脉狭窄患者,随访3～28个月,平均14个月,分别观察技术成功率和围手术期并发症、手术前后神经功能缺损程度、随访期间支架内再狭窄发生情况,以及脑卒中复发率和病死率。结果Apollo支架植入治疗症状性颅内动脉狭窄的技术成功率为91．67％（22／24）,平均狭窄率由手术前（73．23±9．59）％降至手术后（4．12±9．17）％（t=3．325,P=0．005）。围手术期未发生手术相关并发症,手术后神经功能缺损程度显著改善[美国国立卫生研究院卒中量表（NIHSS）评分：（0．59±1．35）比（0．59±1．74）;t=2．718,P=0．015]。临床随访无脑卒中复发或死亡病例．CTA随访无支架内再狭窄。结论Apollo支架植入治疗症状性颅内动脉狭窄可行且安全有效。     

Endovascular Treatment of Ruptured Tiny Intracranial Aneurysms with Low-Profile Visualized Intraluminal Support Device

Background: Ruptured tiny intracranial aneurysms (TIAs) have been challenging both for endovascular and neurosurgical interventions. Thus, we aimed to evaluate the safety and efficacy of low-profile visualized intraluminal support (LVIS) device in the treatment of ruptured TIAs (rTIAs). Material and Methods: Among 761 intracranial aneurysms which were treated either surgically or endovascularly, 32 rTIAs underwent stent-assisted coiling with LVIS device between 2014 and 2017. Patient data were reviewed retrospectively. Clinical and radiological outcomes were recorded at discharge and mid-term follow-up. Results: Mean patient ages were 53 ± 14.5 years. Mean aneurysm size was 2.28 ± .53 mm (range, 1-2.9 mm) with a mean dome:neck ratio of 1.08 (range, .75-2.14). The LVIS stents were successfully implanted in all patients. Mean follow-up period was 9.3 ± 1.9 months (range, 6-15 months). Immediate angiographic evaluation demonstrated complete occlusion in 13 (40.6%) patients, while neck remnant and residual sac were observed in 12 (37.5%) and 7 (21.9%), respectively. All patients had moderate disability (mRS 2-3) at discharge. Number of aneurysms with complete occlusion significantly increased and 82.1% of the patients (23 of 28) demonstrated complete occlusion at follow-up (P?=?.0015). Among these, 27 had good outcome (mRS 0-1; 96.9%) with significant improvement compared to discharge (P?=?.0001). There was no recurrence or enlargement of the residual aneurysms. Additionally, there were no procedure-related complications except the one (3.6%) showing asymptomatic stenosis of the posterior cerebral artery in follow-up imagings. Conclusions: Stent-assisted coiling of rTIAs with LVIS device provides high rates of technical success and complete occlusion at mid-term follow-up with an excellent safety profile.     

椎-基底动脉重度狭窄的血管内治疗

目的回顾性分析椎-基底动脉重度狭窄患者临床诊断与治疗经过,以评价血管内支架成形术的可行性和临床疗效。方法16例椎-基底动脉重度狭窄患者均施行血管内支架成形术,观察其技术成功率、围手术期并发症发生率及远期疗效。结果16例患者经脑血管造影检查共发现27个狭窄病变,共成功植入36枚球囊扩张式支架,技术成功率达100%(16/16)。1例于手术后24h发生支架内急性血栓形成,围手术期并发症发生率为6.25%(1/16)。随访期间,3例(18.75%)发生支架内再狭窄而致卒中再发。结论血管内支架成形术治疗椎-基底动脉重度狭窄,在技术上可行,远期疗效良好。     

Five-year follow-up of stenting for a symptomatic posterior cerebral artery stenosis

Angioplasty and stenting in symptomatic intracranial stenosis is technically possible and may reduce the risk of stroke in patients with symptomatic arterial stenosis. We report a patient with P1 segment stenosis of posterior cerebral artery treated successfully with angioplasty and stenting with a favorable outcome. He had 5 years of clinical and imaging follow-up and no in-stent stenosis or new ischemic event was observed.     

支架成形术治疗症状性颅内动脉狭窄临床分析

目的 分析支架成形术治疗症状性颅内动脉狭窄的临床疗效.方法 选用球扩支架19 例与自膨支架18 例治疗37 例狭窄＞50%的症状性颅内动脉狭窄.结果 球扩支架术前平均狭窄程度78.2%,术后平均狭窄程度7%,技术相关性并发症5 例;自膨支架术前平均狭窄程度79.4%,术后平均狭窄程度22%,技术相关性并发症1 例.结论 自膨支架治疗症状性颅内动脉狭窄具有较好的技术安全性.