不同类型支架治疗症状性大脑中动脉狭窄的疗效和并发症

目的 采用不同类型支架治疗症状性大脑中动脉（MCA）狭窄的临床疗效和并发症。方法回顾性分析采用不同类型支架治疗的64例均为大脑中动脉M1段狭窄（狭窄率≥70％）、药物治疗无效、反复短暂性脑缺血发作或有缺血性卒中的患者的临床资料，其中1例合并同侧颈内动脉海绵窦段重度狭窄，1例合并对侧椎动脉V4段重度狭窄。根据置入支架的不同，将患者分为Wingspan组（25例）、CoroflexBlue组（21例）及Firebird组（18例）。术后采用TCD、DSA及电话进行随访。结果①64例患者MCA支架置人技术成功率为96．9％（62／64）。其中Wingspan组、CoroflexBlue组和Firebird组成功率分别为96．0％（24／25）、95．2％（20／21）和100％，差异无统计学意义。②术后30d内，Wingspan组2例发生脑梗死，其中1例为同侧颈内动脉海绵窦段闭塞引发，1例为MCA的穿支闭塞引发；CoroflexBlue组1例出现频发性室性早搏，1例脑出血；Firebird组1例蛛网膜下腔出血。③术后6～12个月TCD随访显示，9例出现MCA再狭窄，再狭窄率为14．5％（9／62）。其中Wingspan组为16．7％（4／24），CoroflexBlue组为15．0％（3／20），Firebird组为11．1％（2／18），Wingspan组再狭窄率略高，但差异无统计学意义。19例接受DSA随访，其中Wingspan组1例MCA重度狭窄，1例中度狭窄；CoroflexBlue组1例重度狭窄，1例中度狭窄；Firebird组1例支架术后中度狭窄。结论3种支架治疗MCA狭窄均安全、有效；术后再狭窄是值得关注的问题。长期疗效有待于进一步观察。

Efficacy and complications of different types of stents in the treatment of symptomatic middle cerebral artery stenosis

Objective To observe the efficacy and complications of different type of stents in the treatment of symptomatic middle cerebral artery （MCA） stenosis. Methods The clinical data of 64 patients with MCA M1 stenosis treated with different type of stents were analyzed retrospectively. All the patients with MCA stenosis 〉 70% , ineffective after medical therapy and repeated attack of transient ischemia or with ischemic stroke. One of the patients complicated severe stenosis on the cavernous segment of the ip- silateral internal carotid artery, 1 patient complicated severe stenosis on the contralateral vertebral artery （ V4 segment）. The patients were divided into Wingspan （ n = 25 ）, Coroflex Blue （ n = 21 ） and Firebird （n = 18） groups according to the different kind of stents implanted. The patients were followed up with TCD, DSA, and telephone inquiry after the procedure. Results ①The success rate of stent placement for MCA in 64 patients was 96.9% （62/64）. The success rates in the Wingspan, Coroflex Blue and Firebird groups were 96.0% （24/25）, 95.2% （20/21） and 100%, respectively. There were no significant differences.②Within 30 days after procedure, 2 patients had cerebral infarction, and one of them was caused by the ocelusion of the cavernous segment of ipsilateral internal carotid ＇artery, and another was caused hy occlusion of perforating branches of MCA in the Wingspan group; 1 patient had frequent ventrieular presystolic contractions, and another had intracerebral hemorrhage in the Coroflex Blue group; 1 had subarachnoid hemorrhage in the Firebird group. ③The TCD examination at 6 to 12 months after procedure showed that 9（ 14. 5% ） patients had MCA restenosis. The restenosis rate in the Wingspan group was 16.7% （4/24） and in tile Coroflex Blue group was 15.0% （3/20） ,and in the Firehird group was 11.1% （2/18）. The restenosis rate of the sell＇expanding stents was slightly higher, but there was no significant difference. Nineteen patients received DSA angiographic follow-up study, 1 patient had severe MCA stenosis, 1 had moderate stenosis and 4 had no stenosis in the Wingspan group; 1 patients had severe stenosis, 1 had moderate stenosis and 6 had no stenosis in the Coroflex Blue group ; I patient had moderate stenosis 15 months after stenting, and 4 had no stenosis in the Firebird group. Conclusion All the 3 kinds of stents are safe and effeetive for treatment of MCA stenosis. The restenosis after procedure must be concerned. The long-term efficacy remains to be further observed.