支架成形术治疗动脉粥样硬化性进展性脑梗死的疗效观察

目的评价支架成形术(SAA)治疗动脉粥样硬化性进展性脑梗死的临床疗效及安全性。方法选择40例急性大动脉粥样硬化性缺血性进展性脑梗死患者,配对分为SAA组(n=20)与药物治疗组(n=20)。药物治疗组给予阿司匹林、氯吡格雷、他汀类、降压药等常规治疗;SAA组则在常规治疗的基础上进行数字减影血管造影检查,对高度狭窄或伴不稳定斑块的主干动脉予以球囊扩张和SAA治疗。观察两组患者入组时、发病后第21天的美国国立卫生院神经功能缺损(NIHSS)评分、治疗后第90天的改良Rankin量表(mRS)评分;记录治疗过程中出现的不良事件。结果发病后第21天,SAA组NIHSS评分明显低于药物治疗组,差异有统计学意义(P<0.001)。SAA组与药物治疗组mRS评分为0～1分的患者分别为16例和6例,差异有统计学意义(P=0.001)。药物治疗组有1例患者再发脑梗死,SAA组无复发病例。结论 SAA是动脉粥样硬化性进展性脑梗死的有效干预措施。

Stent-assisted angioplasty in treatment of progressive ischemic stroke with atherosclerosis

Objective To investigate the therapeutic effect and safety of stent-assisted angioplasty (SAA) on the progressive ischemic stroke with atherosclerosis. Methods Forty patients with progressive ischemic stroke with large artery atherosclerosis were selected, and were divided into SAA group (n=20) and medication group (n=20). Medication group received conventional treatment with aspirin, clopidogrel, statins and hypotensive drugs. In SAA group, digital subtraction angiography was conducted on the basis of conventional treatment, and balloon dilation and stent-assisted angioplasty were performed for main arteries with severe stenosis and instable plaque. National Institute of Health Stroke Scale (NIHSS) scores were obtained at enrollment and 21 d after disease onset, modified Rankin Scale (mRS) scores were observed 90 d after treatment, and adverse events during the treatment were recorded. Results The NIHSS score of SAA group was significantly lower than that of medication group 21 d after disease onset (P<0.001). The numbers of patients with 0 to 1 for scores of mRS in SAA group and medication group were 16 and 6, respectively (P=0.001). One case in medication group experienced recurrence of stoke, while no recurrence took place in SAA group. Conclusion Stent assisted angioplasty is a feasible therapy for progressive ischemic stroke with atherosclerosis.