脑血管串联狭窄血管内治疗的临床效果

目的初步评价脑血管缺血性串联狭窄行血管内治疗的效果及安全性。方法回顾性分析2013年1月至2018年12月于北京大学第一医院神经外科收治的因2处脑血管狭窄行同期血管内治疗的35例症状性前循环、后循环串联狭窄患者的临床资料。男性27例,女性8例,年龄(65.6±9.4)岁(范围:47~81岁);前循环串联狭窄14例,后循环串联狭窄21例。记录患者术后临床症状、影像学检查结果及改良Rankin量表(mRS)评分等。结果35例患者共植入支架68枚,其中颅外植入49枚,颅内植入19枚,手术成功率100%;围手术期无死亡病例,1例出现术后脑出血(2.9%)。所有患者随访至术后18个月。术后3~12个月,1例(1/35,2.9%)患者出现支架内再狭窄,4例(4/35,11.4%)患者仍有头晕、肢体无力等症状,所有患者mRS评分≤2分,无新发卒中事件;术后12~18个月,新增3例支架内再狭窄患者,支架内再狭窄率为11.4%(4/35),32例患者mRS≤2分(32/35,91.4%)。结论症状性串联狭窄患者同期实施血管内治疗的可操作性强,近期效果良好。

Evaluation of intravascular therapy for cerebral ischemic tandem stenosis

Objective To investigate the efficacy and the safety of intravascular therapy for cerebrovascular ischemic tandem stenosis.Methods Clinical data of 35 patients with symptomatic anterior circulation and posterior circulation tandem stenosis who received intravascular therapy for two sites of stenosis at the same time at Department of Neurosurgery of Peking University First Hospital from January 2013 to December 2018 were analyzed retrospectively.There were 27 males and 8 females,aged(65.6±9.4)years(range:47 to 81 years).There were 14 cases of anterior circulation tandem stenosis and 21 of posterior circulation tandem stenosis.The medical records were collected with emphasis on postoperative symptoms,imaging manifestations and modified Rankin scale(mRS)scores.Results Sixty-eight stents were implants in to 35 patients,including 49 extracranial implants and 19 intracranial implants.The surgical success rate was 100%.The perioperative death rate was 0,and 1 patient(1/35,2.9%)had cerebral hemorrhage.All patients were followed up for 18 months.During 3 to 12 months after the intervention,1 case(1/35,2.9%)had stent restenosis,and 4 cases(4/35,11.4%)had persisted symptoms such as dizziness and weakness in limbs.All patients′mRS scores were≤2.No new stroke occurred.During 12 to 18 months after the intervention,3 cases had in-stent restenosis,increasing the rate to 11.4%(4/35).The mRS scores of 32 patients(32/35,91.4%)were≤2.Conclusion Intravascular therapy for patients with symptomatic tandem stenosis is a feasible and safe procedure with good short-term outcomes.