Department of Cardiovascular Diseases, The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA.
Catheter Cardiovasc Interv. 2012 Jul 1;80(1):121-7. doi: 10.1002/ccd.23439. Epub 2012 Jan 10.
Current "best" medical therapy with anti-platelet and/or anti-thrombotic agents for symptomatic atherosclerotic intracranial (IC) disease is associated with high recurrence. IC catheter-based therapy (CBT) using balloon angioplasty with or without stent placement is an option for patients who have failed medical therapy. We sought to examine the outcomes of CBT for patients with symptomatic IC arterial disease managed by experienced interventional cardiologists.
We retrospectively studied 89 consecutive symptomatic patients with 99 significant (≥70% diameter) IC arterial stenoses who underwent CBT. CBT was performed by experienced interventional cardiologists with the consultative support of a neurovascular team. The primary endpoint was stroke and vascular death.
Procedure success was achieved in 96/99 (97%) lesions and percent diameter stenosis was reduced from 91% ± 7.5% preprocedure to 19% ± 15% postprocedure (P < 0.001). The rate of in-hospital periprocedural stroke and all death was 3%. The primary endpoint of stroke and vascular death rate at 1 year was 5.7% (5/88) and at 2 years was 13.5% (11/81). The 2-year all-cause mortality was 11.3% (10/88).
For patients with symptomatic IC arterial stenosis who have failed medical therapy or are considered very high risk for stroke, CBT performed by experienced interventional cardiologists is safe and offers both high procedural success rates and excellent clinical outcomes at 1 year. CBT is an attractive option for this high-risk patient population considering the expected 12-15% rate of recurrent stroke at 1 year.
目前，对于有症状的粥样硬化性颅内（IC）疾病患者，使用抗血小板和/或抗血栓药物的“最佳”医学治疗与高复发率相关。对于那些药物治疗失败的患者，IC 导管治疗（CBT）是一种选择，包括球囊血管成形术联合或不联合支架置入。我们旨在研究由经验丰富的介入心脏病学家管理的有症状 IC 动脉疾病患者接受 CBT 的结果。
我们回顾性研究了 89 例连续的有症状患者，这些患者有 99 处显著（≥70%直径）IC 动脉狭窄，接受了 CBT。CBT 由经验丰富的介入心脏病学家进行，同时得到神经血管团队的咨询支持。主要终点是卒中和血管性死亡。
99 处病变中有 96 处（97%）达到了手术成功，术前狭窄程度为 91%±7.5%，术后为 19%±15%（P<0.001）。住院期间围手术期卒中发生率和全因死亡率为 3%。1 年时卒中和血管性死亡的主要终点发生率为 5.7%（5/88），2 年时为 13.5%（11/81）。2 年全因死亡率为 11.3%（10/88）。
对于药物治疗失败或卒中风险极高的有症状的 IC 动脉狭窄患者，由经验丰富的介入心脏病学家进行的 CBT 是安全的，在 1 年时可提供高的手术成功率和出色的临床结果。考虑到 1 年内复发卒中的预期率为 12-15%，CBT 是这一高危患者群体的一个有吸引力的选择。
