Boston University School of Medicine, Boston, MA, USA.
Stroke. 2011 Jan;42(1):107-11. doi: 10.1161/STROKEAHA.110.583245. Epub 2010 Nov 11.
whether stenting is superior to angioplasty in the treatment of intracranial atherosclerotic disease is unknown. Dissections, vessel rupture, and lesion recoil observed with primary angioplasty using balloon catheters designed for coronary arteries have undermined the role of primary angioplasty as a preferred treatment for intracranial atherosclerotic disease. The goal of this study is to report the immediate and 3-month outcomes of treating patients with intracranial atherosclerotic disease with angioplasty balloon catheters in a multicenter study.
this is a retrospective review of 74 patients from 4 institutions treated with primary angioplasty for intracranial atherosclerotic disease over a 6-year time period. Technical success (residual stenosis ≤ 50%), periprocedural success (no vascular complication within 72 hours), and 3-month outcomes are reported.
the mean degree of stenosis pretreatment was 79% ± 14% and reduced to 34% ± 18% after angioplasty. Technical success was achieved in 68 (92%; 95% CI, 83% to 97%) of the 74 patients. Periprocedural success was achieved in 65 (88%; 95% CI, 78% to 94%) of the 74 patients. There were 4 (5%; 95% CI, 1.5% to 13%) major procedure-related strokes, 2 of which resulted in death within 6 hours of the procedure. The 30-day stroke/death rate was 5% (4 of 74; CI, 1.5% to 13%). Three-month follow-up was available in 71 patients. In this interval, 2 patients had new stroke, 1 in the ipsilateral territory and the other in the contralateral territory. The 3-month stroke or death rate was 8.5% (6 of 71; CI, 3.1% to 17.5%); the retreatment rate was 2.8% (2 of 71; CI, 0.3% to 10%).
balloon angioplasty is a relatively safe alternative treatment for intracranial atherosclerotic disease. Its role in the long-term secondary prevention of recurrent stroke as compared with intracranial stenting and medical therapy remains to be determined, preferably in a randomized study.
在颅内动脉粥样硬化疾病的治疗中，支架置入术是否优于血管成形术尚不清楚。在使用专为冠状动脉设计的球囊导管进行原发性血管成形术中，观察到夹层、血管破裂和病变回缩，这削弱了原发性血管成形术作为颅内动脉粥样硬化疾病首选治疗方法的作用。本研究的目的是报告在一项多中心研究中，使用血管成形术球囊导管治疗颅内动脉粥样硬化疾病患者的即刻和 3 个月的结果。
这是对 4 家机构的 74 例接受原发性血管成形术治疗颅内动脉粥样硬化疾病的患者进行的回顾性研究，研究时间为 6 年。报告了技术成功率（残余狭窄率≤50%）、围手术期成功率（72 小时内无血管并发症）和 3 个月的结果。
治疗前平均狭窄程度为 79%±14%，血管成形术后降至 34%±18%。74 例患者中，68 例（92%；95%置信区间，83%至 97%）达到技术成功。74 例患者中，65 例（88%；95%置信区间，78%至 94%）达到围手术期成功。4 例（5%；95%置信区间，1.5%至 13%）发生主要与手术相关的卒中，其中 2 例在手术后 6 小时内死亡。30 天的卒中/死亡率为 5%（4/74；置信区间，1.5%至 13%）。71 例患者可获得 3 个月的随访。在此期间，2 例患者发生新的卒中，1 例在同侧，另 1 例在对侧。3 个月的卒中或死亡率为 8.5%（6/71；置信区间，3.1%至 17.5%）；再次治疗率为 2.8%（2/71；置信区间，0.3%至 10%）。
球囊血管成形术是颅内动脉粥样硬化疾病的一种相对安全的替代治疗方法。与颅内支架置入术和药物治疗相比，其在复发性卒中的长期二级预防中的作用仍有待确定，最好在随机研究中确定。
