Park Tae Sik, Choi Beom Jin, Lee Tae Hong, Song Joon Suk, Lee Dong Youl, Sung Sang Min
Department of Neurosurgery, Wallace Memorial Baptist Hospital, Busan, Korea.
J Korean Neurosurg Soc. 2011 Oct;50(4):322-6. doi: 10.3340/jkns.2011.50.4.322. Epub 2011 Oct 31.
Stenting of symptomatic intracranial stenosis has recently become an alternative treatment modality. However, urgent intracranial stenting in patients with intracranial stenosis following a transient ischemic attack (TIA) or minor stroke is open to dispute. We sought to assess the feasibility, safety, and effectiveness of urgent intracranial stenting for severe stenosis (>70%) in TIA or minor stroke patients.
Between June 2009 and October 2010, stent-assisted angioplasty by using a balloon-expandable coronary stent for intracranial severe stenosis (>70%) was performed in 7 patients after TIA and 5 patients after minor stroke (14 stenotic lesions). Technical success rates, complications, angiographic findings, and clinical outcomes were retrospectively analyzed.
Stenting was successful in all 12 patients. The mean time from symptom onset to stenting was 2.1 days (1-8 days). Post-procedural angiography showed restoration to a normal luminal diameter in all patients. In-stent thrombosis occurred in one patient (n=1, 8.3%), and was lysed with abciximab. No device-related complications, such as perforations or dissections at the target arteries or intracranial hemorrhaging, occurred in any patient. The mortality rate was 0%. No patient had an ischemic event over the mean follow-up period of 12.5 months (range, 7-21 months), and follow-up angiography (n=7) revealed no significant in-stent restenosis (>50%).
Urgent recanalization with stenting is feasible, safe, and effective in patients with TIA or acute minor stroke with intracranial stenosis of ≥70%.
有症状的颅内狭窄支架置入术近来已成为一种替代治疗方式。然而，短暂性脑缺血发作（TIA）或轻度卒中后颅内狭窄患者的紧急颅内支架置入术仍存在争议。我们试图评估TIA或轻度卒中患者紧急颅内支架置入治疗严重狭窄（>70%）的可行性、安全性及有效性。
2009年6月至2010年10月，对7例TIA后及5例轻度卒中后颅内严重狭窄（>70%）患者采用球囊扩张式冠状动脉支架行支架辅助血管成形术（共14个狭窄病变）。对技术成功率、并发症、血管造影结果及临床结局进行回顾性分析。
12例患者支架置入均成功。从症状发作到支架置入的平均时间为2.1天（1 - 8天）。术后血管造影显示所有患者管腔直径恢复正常。1例患者（n = 1，8.3%）发生支架内血栓形成，用阿昔单抗溶解。所有患者均未发生与器械相关的并发症，如靶动脉穿孔或夹层形成或颅内出血。死亡率为0%。在平均12.5个月（范围7 - 21个月）的随访期内，无患者发生缺血事件，7例患者的随访血管造影显示无明显的支架内再狭窄（>50%）。
对于颅内狭窄≥70%的TIA或急性轻度卒中患者，紧急支架再通术是可行、安全且有效的。
