支架成形术与药物治疗重度颅内动脉狭窄的长期疗效对比

目的探讨重度颅内动脉粥样硬化性狭窄（ICAS）的支架成形术（SAA）与单纯药物治疗的长期疗效。方法回顾性分析2009年12月-2012年3月ICAS致短暂性脑缺血发作或脑梗死人院208例患者的临床资料，根据患者的选择分为SAA组（均用Wingspan支架）122例，药物治疗组86例。神经功能改善率以治疗前后美国国立卫生研究院卒中量表（NIHSS）评分差值／治疗前NIHSS评分的比值评价。主要终点事件为30d内出现的脑血管事件和死亡，次要终点事件为30d后责任血管相关缺血性脑血管事件。比较两组患者的围手术期并发症，再发脑血管事件、死亡等随访结果。结果每3个月随访1次，随访4-36个月，平均（19．3±1．7）个月。①SAA组30d，6、12、18、24个月的神经功能改善率分别为4．9％、45．1％、57．4％、53．3％和55．0％；药物组为3．5％、26．7％、20．9％、24．4％和23．2％，两组30d后的神经功能改善率差异有统计学意义（P〈0．01）。②SAA组手术成功率为98．4％。术后30d内，SAA组共有4例发生围手术期严重并发症，另有2例症状轻微。药物组30d内有2例（2．3％）发生狭窄动脉区轻微卒中；30d内两组的主要终点事件发生率差异无统计学意义。③SAA组30d后责任血管发生缺血事件为7例（5．7％），药物组为15例（17．4％）出现责任血管缺血性脑血管事件，两组次要终点事件发生率差异有统计学意义（P〈0．01）。结论血管内SAA治疗ICAS较为安全，在预防责任血管相关的缺血性脑血管事件与改善神经功能方面，长期疗效优于内科药物治疗。

Comparison of long-term efficacy of stent-assisted angioplasty and medical treatment for severeintracranial artery stenosis

Objective To investigate the long-term efficacy of stent-assisted angioplasty （SAA） and medical treatment alone for severe intracranial atheroselerotic stenosis （ICAS）. Methods The clinical data of 208 patients with transient ischemie attack or cerebral infarction attributed to ICAS from December 2009 to March 2012 were analyzed retrospectively. According to the choice of patients, they were divided into either a SAA group （ n = 122） or a drug treatment group （ n = 86 ）. Neurological improvement rate was evaluated with the National Institutes of Health Stroke Scale （NIHSS） score differences before and after treatment/NIHSS score ratio before treatment. The primary endpoint events were cerebrovascular event and death within 30 days ,the secondary endpoint event was guilty vessel-related ischemic eerebrovas eular event after 30 days. The patients＇ perioperative complications, recurrent cereb rovascular events, and the incidence of death in both groups were compared. The patients were followed up for every 3 months. They were followed up for 4 to 36 （ mean 19. 3 ：t： 1. 7） months. Results ①The neurological improvement rates at day 30, 6, 12, 18, and 24 months in the SAA group were 4.9% ,45.1%, 57.4%, 53.3%, and 55%, respectively and those in the drug treatment group were 3.5%, 26.7%, 20.9%, 24. 4%, 23. 2%, respectively. There were significant differences in neurological function improvement rates after 30 days between the two groups （ P 〈 0.01 ）. ②The procedure success rate of the SAA group was 98.4%. Within 30 days after procedure, four patients in the SAA group had severe perioperative complications, and two had minor symptoms. Two patients （2.3 % ） in the drug treatment group had minor stroke in the stenotic artery areas. There were no significant differences in primary endpoint event rates within 30 days between the two groups. ③Ischemic events occurred in the guilty vessels in 7 patients （5.7%） after 30 days in the SAA group, and ischemic events occurred in the guilty vessels in 15 patients （17.4%） in the drug treatment group. There was no significant difference in the incidence of the secondary endpoint events between the two groups （P 〈 0. 01 ）. Conclusion The treatment of ICAS with endovascular SAA is safe. The long-term efficacy in the prevention of guilty vessel-related ischemic cerebro vascular events and the improvement of neurological function is superior to medical treatment.