Department of Neuroradiology, Montpellier University Hospital, Montpellier, France.
J Neurosurg. 2011 Oct;115(4):686-93. doi: 10.3171/2011.5.JNS101583. Epub 2011 Jul 8.
The limitations of the medical management of symptomatic intracranial arterial stenosis (SIAS) have encouraged the development of new strategies, such as endovascular treatment. In this study, the authors report and analyze a series of 63 endovascular procedures in which the Wingspan stent system was used.
Data from 60 patients presenting with refractory SIAS, treated in 5 French neurointerventional centers between September 2006 and August 2009, were retrieved. An angiogram was systematically obtained 6 months after the procedure and yearly thereafter. The clinical neurological status was assessed and reported using the modified Rankin scale at 1-month, 6-month, and 1-year follow-up visits.
A total of 63 stenotic lesions was treated. The mean age of the patients was 65.3 years, and the mean diameter of the stenosis was 80.2%. Technical success was achieved in 95.2% of cases. The overall incidence of procedural complications was 20.6%, with a 4.8% rate of permanent postoperative morbidity and death. In-stent restenosis (ISR)/occlusion occurred in 11 cases (17.4%), of which 10 were asymptomatic and 9 were detected less than 1 year from the endovascular treatment. In 1 case, the patient presented with a recurrent transient ischemic attack and was treated again with angioplasty. The mean follow-up was 13.2 months.
Endovascular treatment of SIAS demonstrates a moderate risk of neurological complication. Nevertheless, considering the critical natural history of severe refractory lesions, this may be considered the first alternative in cases of failed medical therapy. Technical failure, residual stenosis, or in-stent restenosis did not lead to systematic recurrent stroke in this series, which suggests the importance of plaque stabilization and neoendothelialization.
症状性颅内动脉狭窄（SIAS）的医学治疗局限性促使人们开发了新的策略，如血管内治疗。在这项研究中，作者报告和分析了使用 Wingspan 支架系统进行的 63 例血管内治疗。
从 2006 年 9 月至 2009 年 8 月在 5 家法国神经介入治疗中心就诊的 60 例难治性 SIAS 患者中检索数据。系统地在术后 6 个月和此后每年进行血管造影检查。在 1 个月、6 个月和 1 年的随访中使用改良 Rankin 量表评估和报告临床神经状态。
共治疗 63 个狭窄病变。患者的平均年龄为 65.3 岁，狭窄的平均直径为 80.2%。技术成功率为 95.2%。总的手术并发症发生率为 20.6%，永久性术后发病率和死亡率为 4.8%。支架内再狭窄（ISR）/闭塞发生在 11 例（17.4%）中，其中 10 例无症状，9 例在血管内治疗后不到 1 年发现。在 1 例患者中，患者出现复发性短暂性脑缺血发作，再次接受血管成形术治疗。平均随访时间为 13.2 个月。
SIAS 的血管内治疗显示出中度神经并发症风险。然而，考虑到严重难治性病变的临界自然史，这可能被视为药物治疗失败后的首选方案。在本系列中，技术失败、残余狭窄或支架内再狭窄并未导致系统性复发性中风，这表明斑块稳定和新生内皮化的重要性。
