Institute of Neuroradiology, University of Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
Cardiovasc Intervent Radiol. 2010 Oct;33(5):914-20. doi: 10.1007/s00270-009-9744-y. Epub 2009 Nov 12.
The purpose of this investigation was to provide a detailed description of the angiographic results after stenting of high-grade intracranial stenosis using balloon-expandable stents. Forty consecutive patients with symptomatic atherosclerotic intracranial stenosis >50% received endovascular treatment by placement of balloon-expandable stents using the concept of slight underdilation and strict avoidance of overdilation. Intra-arterial digital subtraction angiography images before and after stenting in the same projection were reviewed for pre- and post-therapeutic measurement of the degree of stenosis and evaluation of morphologic criteria like plaque coverage, stent apposition, patency of side branches, and signs of dissection or vasospasm. Stenting decreased the mean percentage stenosis from 76.2 (WASID criteria) to 20.8%. Residual stenosis ranged from 0 to 55% with residual stenosis >50% in two of 40 cases. Technical success rate was 95%. There were no major vessel complications, but minor abnormalities like incomplete stent apposition (8/40) or plaque coverage (7/40), incomplete filling of side branches (13/40), and minor dissections after stenting (2/40) were seen. One case with incomplete stent apposition and two cases with side branch compromise were associated with clinical symptoms. In conclusion, intracranial stenting with slight underdilation avoided major vessel complication and created reliable luminal gain. Suboptimal recanalization results were frequently detected and may be the source of neurological complications in individual cases.
本研究旨在详细描述使用球囊扩张支架治疗高分级颅内狭窄的血管造影结果。40 例有症状的粥样硬化性颅内狭窄>50%的患者接受了血管内治疗，通过使用轻微过度扩张的概念和严格避免过度扩张的方法放置球囊扩张支架。在同一投照角度下，对支架置入前后的动脉数字减影血管造影图像进行了回顾性分析，用于治疗前后狭窄程度的测量以及形态学标准的评估，如斑块覆盖、支架贴壁、侧支通畅性和夹层或血管痉挛的迹象。支架置入使狭窄程度从 76.2%（WASID 标准）降低至 20.8%。残余狭窄程度为 0 至 55%，40 例中有 2 例残余狭窄>50%。技术成功率为 95%。无主要血管并发症，但可见轻微异常，如支架不完全贴壁（8/40）或斑块覆盖不全（7/40）、侧支不完全充盈（13/40）和支架置入后轻微夹层（2/40）。1 例支架不完全贴壁和 2 例侧支受压的病例与临床症状相关。总之，轻微过度扩张的颅内支架置入术避免了主要血管并发症，并获得了可靠的管腔再通。经常发现不太理想的再通结果，这可能是个别病例发生神经并发症的原因。
