磁共振弥散成像评价颅内动脉狭窄支架成形术后新发缺血性脑损害

目的探讨颅内动脉狭窄WingSpan支架成形术后早期发生缺血性脑损害的情况，以评估支架成形术早期的安全性。方法前瞻性分析连续人院的29例症状性颅内动脉狭窄行Wing．Span支架成形术治疗的患者。在支架成形术前、术后（72h内）行磁共振弥散成像（DWI）检查，记录新发缺血性脑损害的情况，结合患者一般临床情况、手术情况等，评价WingSpan支架成形术治疗颅内动脉狭窄早期的安全性。结果支架成形术后72h内总体临床并发症发生率为17．2％（5／29，包括血尿、便血、上消化道出血等），神经系统临床并发症发生率为6．9％（2／29例）。永久神经功能障碍的发生率为0，无死亡病例。术后DW1检出的新发缺血性脑损害13例（44．8％），其中无症状者11例，有临床症状者2例。13例中，共检出新发缺血性脑损害病灶63个，其中55个位于靶血管供血区域（87．3％），8个位于非靶血管供血区域（12．7％）；2个出现在（3．2％）支架覆盖血管相关穿支供血区域。13例中，5例病变为LMA分型中的Ⅱ～Ⅲ型径路，4例行球囊预扩张时发生移位。结论DWI检查在评价颅内动脉狭窄支架成形术中的安全性具有重要参考价值。应用WingSpan支架系统治疗症状性颅内动脉狭窄，围手术期较为安全，但术后早期有一定比例的缺血性脑损害发生，并且与支架成形术相关操作以及病变本身的解剖特点有关。

New ischemic brain damage detected by early diffusion-weighted imaging after stenting for intracranial artery stenosis

objective To investigate early isehemic brain damage after stenting for intracranial artery stenosis in order to assess its safety early. Methods Twenty-nlne consecutive patients with symptomatic intracranial arterial stenosis whom underwent WingSpan stenting were analyzed retrospectively. Diffusion- weighted imaging （DWI） was performed before and after stenting （within 72 hours）. The new ischemie brain damages were documented. The early safely of WingSpan stenting for intracraniai artery stenosis was assessed according to the general clinical and surgical conditions of the patients. Results The overall in- cidence of clinical complications occurred within 72 h after stentlng was 17.2% （5/29） , including hema- turia, hemafecia, upper gastrointestinal bleeding, etc. The incidence of temporal neurological complica- tions was 6.9% （2/29）. No permanent neurological complication and no mortality occurred. Thirteen pa- tients had newly developed ischemic brain damages （44.8%） were detected by DWI, 11 of them （84. 6% ） were asymptomatic, and 2 （ 15.4% ） had clinical symptoms. A total of 63 newly developed ischemic brain damages were detected in 13 patients, 55 of them （87.3%） in the target blood supply area, 8 （12.7%） in the non-target blood supply area, and 2 （3.2%） in the stent-covered vascular related perforator blood supply area. Among these patients, five patients have severe tortuosity access （type Ⅱ and Ⅲ, LMA clas- sification）, and migration occurred in four patients during balloon angioplasty. Conclusion DWI exami- nation has important evaluative value in the assessment of the safety of stenting for intraeranial artery stenosis. The treatment of symptomatic intraeranial artery stenosis by using WingSpan system is safe during the perioperative period, however, a certain patients occurred early postoperative ischemic brain damages, it is associated with stent-related procedures and anatomical characteristics of the ischemic brain damage itself.