Lopes Demetrius Klee, Ringer Andrew J, Boulos Alan S, Qureshi Adnan I, Lieber Baruch B, Guterman Lee R, Hopkins L Nelson
Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
Neurosurgery. 2003 Jun;52(6):1275-8; discussion 1278-9. doi: 10.1227/01.neu.0000064567.15270.27.
One concern with respect to stent procedures performed to treat patients with intracranial lesions is the fate of normal major arterial branches after stents are placed across them. Because most of these lesions occur at vessel bifurcations or at branch points, a normal major branch often arises near the lesion and may be difficult to avoid during stent positioning. The aim of this article is to describe the angiographic outcome of intracranial major branch arteries crossed by a stent in the intracranial circulation.
We examined the immediate postprocedural cerebral angiograms of the 40 patients who underwent intracranial stenting at the University at Buffalo, Buffalo, NY, between June 1998 and April 2000. In each of 10 patients, the stent was placed across a normal major branch artery. Stents were used to treat aneurysms in seven patients and intracranial stenosis in three patients. The latest cerebral angiogram available was reviewed, and the patency of the major branch arteries was evaluated.
The angiographic follow-up period ranged from 4 days to 35 months (mean follow-up, 10 mo). Each of the 10 major branch arteries was patent. No infarcts were associated with the territory of the major branch arteries crossed by the stents, and no patient experienced a related episode of clinical ischemia. Four patients died as a result of causes unrelated to the stenting procedure. The histology of a middle cerebral artery stent that was placed across a lenticulostriate perforator is presented.
The flexible, low-profile stents used in this study had no angiographically or clinically apparent effect on the major intracranial branches across which they were placed.
在对颅内病变患者进行支架置入手术时，一个令人关注的问题是，当支架横跨正常的主要动脉分支放置后，这些分支的转归情况。由于大多数此类病变发生在血管分叉处或分支点，正常的主要分支常常在病变附近发出，在支架定位过程中可能难以避开。本文的目的是描述在颅内循环中被支架横跨的颅内主要分支动脉的血管造影结果。
我们检查了1998年6月至2000年4月期间在纽约州布法罗市布法罗大学接受颅内支架置入术的40例患者术后即刻的脑血管造影图像。在10例患者中，每例患者的支架均横跨一条正常的主要分支动脉放置。7例患者使用支架治疗动脉瘤，3例患者使用支架治疗颅内狭窄。回顾了可获得的最新脑血管造影图像，并评估主要分支动脉的通畅情况。
血管造影随访期为4天至35个月（平均随访10个月）。10条主要分支动脉均通畅。没有梗死与被支架横跨的主要分支动脉供血区域相关，也没有患者经历相关的临床缺血发作。4例患者因与支架置入手术无关的原因死亡。展示了一条横跨豆纹状穿支放置的大脑中动脉支架的组织学情况。
本研究中使用的可弯曲、低轮廓支架，对其横跨的颅内主要分支在血管造影或临床上均无明显影响。
