血管内支架成形术治疗颅内动脉狭窄28例

目的探讨血管内支架成形术治疗颅内动脉狭窄的临床效果和安全性。方法 2006年7月—2010年12月,采用经皮血管内支架成形术治疗颅内狭窄28例。结果治疗狭窄颅内动脉28支,其中置入冠脉球扩式支架16枚,Wingspan支架6枚,apollo支架6枚,支架不能到位,放弃手术1例。27支动脉狭窄程度均明显改善,狭窄程度由原来的（89.36±5.63）%下降至（4.23±1.57）%,无死亡病倒,术后27例患者症状均明显改善,1例基底动脉重度狭窄患者术后出现一侧肢体麻木的并发症,1例术后出现脑栓塞表现,3 d后恢复正常,其他26例患者无并发症,随访2～12个月,无短暂性脑缺血发作（TIA）发作,随访患者经颅多普勒超声（TCD）结果显示,原狭窄血管近端、远端血流速度和支架置入后24 h的TCD结果无明显差别。结论血管内支架成形术是治疗症状性颅内动脉狭窄的安全、有效的方法,临床效果好,并发症少。适应证的正确选择、术中熟练的导管导丝技术和围术期的专业处理是手术成功的关键,但其远期疗效还需要长期随访。

Angioplasty and stenting for treatment of symptomatic intracranial artery stenosis in 26 cases

Objective To analyze the clinical result and safety of treating symptomatic intracranial artery stenosis with angioplasty and stenting. Methods 28 patients with symptomatic intracranial artery stenosis were treated between July 2006 and December 2010. Results 28 lesions were treated with 16 ballon-expandable coronary stent,6 wingspan stent and 6 Apollo stent.Stent can not be put in place,to give up surgery in 1 case.The diameter stenosis of artery were excellent changed after angioplasty and stenting,and the diameter stenosis were decreased from（89.36±5.63）% to（4.23±1.57）%.No death occurred.The symptom and signs were progressed excellently in 27 cases after angioplasty and stenting,1 case of basilar artery stenosis in patients with severe postoperative had a complications with unilateral limb numbness,1 patient had cerebral embolism,3 days after the return to normal,the other 26 patients without complications.The patients were followed up for two to twelve months,no transient ischemic attack（TIA） occurred.Transcranial Doppler（TCD） examination showed that there was no significant difference in distal and proximal blood flow velocity of original stenosis artery and 24h TCD results. Conclusion Angioplasty and stenting is safe and effective treatment for symptomatic intracranial artery stenosis with fewer complications.The selection for indication,special treatment during operation period and skillful technique were the keys of success,but the long-term follow-up needs further investigation.