症状性大脑中动脉狭窄的血管内治疗

目的总结大脑中动脉狭窄的血管内治疗的策略、方法、术中风险及术后疗效。方法回顾性分析2008年2月至2010年1月治疗的28例经药物治疗无效、反复短暂性脑缺血发作(TIA)或有明显脑缺血症状、采用血管内治疗的症状性大脑中动脉狭窄患者的治疗及术后随访。结果 28例患者中,根据病变的Mori分型选择合理术式,18例行球囊扩张术,10例行支架置入术。平均狭窄率由86%降至15%;无不良事件发生。术后随访6~24个月,28例TIA症状消失,球扩组中1例于3个月后、另1例于6个月后TCD复查提示发生再狭窄,无相关临床症状。结论球囊扩张术及支架置入术治疗大脑中动脉狭窄是可行、有效的,同时都有难以避免的并发症。临床中应注重积累经验,综合客观评价病变血管情况,选择合理的介入治疗方法,才能使患者最大程度获益,并尽可能降低治疗风险.

Endovascular Interventional Treatment for Symptomatic Stenosis of Middle Cerebral Artery

Objective To summarize the strategy,methods,security and validity of percutaneous angioplasty（PTA）or percutancous angioplasty and stenting（PTAS）for symptomatic stenosis of middle cerebral artery.Methods The results of treatment and follow up of 28 cases from Feb,2008 to Jan,2010 with symptomatic stenosis of middle cerebral artery who had either recurrent transient ischemic attacks（TIA）or resistant to medical therapy and were performed PTA or PTAS were studied retrospectively.Results According to Mori types stent implantation or balloon angioplasty was performed in patients.10 of the 28 patients were performed stent implantation successfully,and others were performed balloon angioplasty,the average lumen diameter increased from 15%to 86%,and no complication was occurred.During the following up 6~24 months,the symptoms of TIA disappeared in 28 patients.In patients treated with balloon angioplasty,the symptoms of TIA recurred in 1 patient after 3 months,while another was instenosis after 6 months according to TCD results,and the 2 patients had no obvious symptom of ischemia.Conclusion PTA or PTAS is a feasible,safe and effective therapeutic method for patients with symptomatic stenosis of middle cerebral artery with unavoidably complication.To choose the suitable procedure according to the accumulation of abundant clinical experience and comprehensive encephalitis access may be an effective approach to minimize the severe complications.