Lylyk Pedro, Vila José F, Miranda Carlos, Ferrario Angel, Musacchio Alejandro, Rüfenacht Daniel, Cohen José E
Department of Neurosurgery, Endovascular Neurosurgery and Interventional Neuroradiology, ENERI, Clínica Médica Belgrano, Buenos Aires, Argentina.
Neurol Res. 2005;27 Suppl 1:S84-8. doi: 10.1179/016164105X35495.
Patients with intracranial atherosclerosis who fail antithrombotic therapy have a poor prognosis. The high rate of recurrent stroke warrants testing alternative treatments such as intracranial angioplasty.
We present our experience in the treatment of 104 patients (age range, 54-82 years; mean age, 67 years) with symptomatic intracranial atherosclerotic stenoses despite medical therapy who underwent stent-assisted angioplasty. Patient records were retrospectively analysed for location and degree of stenosis, regimen of antiplatelet agents, devices used, procedure-related complications and adverse events. Clinical (Modified Rankin Scale) and radiographic outcomes were obtained 24 hours, 1 month and 3-6 months after treatment. Sixty-five lesions (62.5%) were located in the posterior circulation. Mean stenosis was 75.4%.
In all patients, the angiographic degree of stenosis was reduced to less than 30%. One stent was implanted in 66 patients (63%), and two or more in 38 patients (37%). Modified Rankin Scale (mR) was 1-2 in 67.5% of the cases, 3-4 in 25.9%, 5 in 2.8%, 6 in 3.8%. Procedural morbidity was 5.7% and procedural mortality was 3.8%. Angiographic follow-up was available in 58 patients (55.7%) and the restenosis rate was 12.5%.
In selected patients, endovascular revascularization of intracranial arteries by means of stent-assisted angioplasty is technically feasible, effective and safe.
抗血栓治疗失败的颅内动脉粥样硬化患者预后较差。复发性卒中的高发生率使得有必要测试诸如颅内血管成形术等替代治疗方法。
我们介绍了104例（年龄范围54 - 82岁；平均年龄67岁）尽管接受了药物治疗但仍有症状性颅内动脉粥样硬化狭窄的患者接受支架辅助血管成形术的治疗经验。对患者记录进行回顾性分析，以了解狭窄的部位和程度、抗血小板药物治疗方案、使用的器械、与手术相关的并发症和不良事件。在治疗后24小时、1个月和3 - 6个月获得临床（改良Rankin量表）和影像学结果。65个病变（62.5%）位于后循环。平均狭窄率为75.4%。
所有患者的血管造影狭窄程度均降至30%以下。66例患者（63%）植入了1个支架，38例患者（37%）植入了2个或更多支架。改良Rankin量表（mR）评分1 - 2分的病例占67.5%，3 - 4分的占25.9%，5分的占2.8%，6分的占3.8%。手术并发症发生率为5.7%，手术死亡率为3.8%。58例患者（55.7%）进行了血管造影随访，再狭窄率为12.5%。
在选定的患者中，通过支架辅助血管成形术对颅内动脉进行血管内血运重建在技术上是可行的、有效且安全的。
