症状性大脑中动脉狭窄的介入治疗

目的评价血管内支架植人术和球囊扩张术对症状性大脑中动脉狭窄的疗效。方法对37例反复发生短暂性脑缺血（TIA）的大脑中动脉狭窄患者，根据Mori和治疗路径分型选择手术方式：路径I、Ⅱ型且MoriA型行支架植入术；路径III型或MoriB、C型采用球囊扩张术。结果21例行支架植入术，16例行球囊扩张术。支架植入术组成功扩张20例，狭窄率由76％降至12％；1例术后因血管破裂而死亡。球囊扩张术组成功扩张14例，狭窄率由69％降至15％，1例由于路径过度纡曲失败。术后随访，支架植入组17例TIA症状消失，2例症状有明显改善，2例TIA复发；球囊扩张术组12例TIA消失，4例TIA复发。结论两种方法治疗MCA狭窄均有效，根据Mori及手术入路分型合理选择介入手术方式可能是提高手术成功率的较好策略。

Interventional treatment for patients with symptomatic middle cerebral artery stenosis

Objective To evaluate the curative effects of stent implantation and balloon angioplasty in patients with symptomatic middle cerebral artery （MCA） stenosis. Methods Thirty seven patients with recurrent transient ischemic attacks （TIA） were classified according to the affection blood vessel （Mori type） and treatment pathway. Stent implantation was performed in patients with Mori type A and access type I or II , while balloon angioplasty in patients with Mori type B or C and access type Ⅲ. Results The stent implantation was performed successfully in 20 of the 21 patients, and lumen diameter increased from 12% to 76%. One patient died of vascular rupture after the operation. The balloon angioplasty was performed successfully in 14 of the 16 patients, and lumen diameter increased from 15% to 69%, but failed in one patient for the excess pathway circuity. During the following up period, in 21 patients treated with stent implantation, the symptoms of TIA disappeared in 17 patients, markedly improved in 2 patients, while recurrent TIA was found in 2 patients. In 16 patients treated with balloon angioplasty, the symptoms of TIA disappeared in 12 patients and recurred in 4 patients. Conclusion Both stent implantation and balloon angioplasty is effective in treating MCA stenosis. To choose the suitable procedure according to the classifications of Mori and access may be an effective approach to minimize the severe complications of stent implantation or balloon angioplasty in treatment of MCA stenosis.