两种方式治疗大脑中动脉狭窄的疗效与安全性比较

目的 比较血管内支架成形术与内科方式治疗青年严重症状性大脑中动脉狭窄患者脑卒中二级预防的疗效及安全性.方法 收集该院2011年1月至2015年6月经全脑血管造影术明确的严重症状性大脑中动脉狭窄(狭窄率大于或等于70％)患者77例,分为血管内支架成形术组和内科治疗组,评估入院时改良Rankin评分(mRS评分)、美国国立卫生院卒中量表(NIHSS)评分及入组后1年内mRS评分和缺血性卒中复发、死亡、脑出血事件.结果 血管内支架成形术组与内科治疗组30 d内主要终点事件发生率分别为0％、5.77％,1年内卒中复发率分别为4.35％、13.46％,两组比较差异无统计学意义(P＞0.05).两组均无死亡、脑出血发生.血管内支架成形术组与内科治疗组随访1年时mRS≤1分患者比例分别为91.30％、69.23％,两组比较差异有统计学意义(P＜0.05);mRS≤2分的患者分别为95.65％、84.62％,两组比较差异无统计学意义(P＞0.05).结论 血管内支架成形术在严重症状性大脑中动脉狭窄是安全的,对降低青年再发卒中风险比内科治疗更有效.

Comparison of the efficiency and safety of two different treatments in middle cerebral artery stenosis

Objective To evaluate the efficacy and safety of percutaneous transluminal angioplasty and stenting of intravascular stenting (PTAS) and internal medicine in the treatment of secondary severe stroke in young patients with severe symptomatic middle cerebral artery stenosis.Methods The clinical data of 77 cases with severe symptomatic middle cerebral artery stenosis(ste nosis rate≥70％)confirmed by digital subtraction angiography(DSA) were collected retrospectively in our hospital from January 2011 to June 2015.The patients were divided into PTAS group and medical treatment group,and the data were collected including the modified Rankin Score (mRS score) at admission,the US National Institutes of Health Stroke volume neurological impairments score (NIHSS score)at admission,as well as mRS score,the recurrence of ischemic stroke,death and intracerebral hemorrhage within 1 year.Results The primary end-point rates within 30 days after enrollment in PTAS group and medical treatment group were 0％ and 5.77％ respectively,and the stroke recurrence rates within 1 year were 4.35％ and 13.46％ respectively,The differ ence was not statistically significant(P＞0.05).Meanwhile,there was no death and intracerebral hemorrhage in both two groups.The rates of mRS≤1 were 91.30 ％ and 69.23 ％ respectively in PTAS group and medical treatment group,and the difference was statistically significant (P＜0.05).The rates of mRS≤2 were 95.65 ％ and 84.62 ％ respectively in PTAS group and medical treat ment group,and the difference was not statistically significant(P＞0.05).Conclusion PTAS is safe for the severe symptomatic middle cerebral artery stenosis,and is more efficient in dectasing the risk of recurrent stroke in young population compared with medical treatment.