Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.
Int J Stroke. 2013 Feb;8(2):87-94. doi: 10.1111/j.1747-4949.2011.00715.x. Epub 2012 Feb 1.
Comparing safety and technical success of balloon-expandable stents and self-expanding stents for intracranial angioplasty and stenting in medically refractory intracranial atherosclerotic disease in a single center series.
Fifty-four self-expanding stents and 46 balloon-expandable stents were implanted in 100 consecutive patients (mean age 64 years, 74% male) from April 2000 to September 2009. All patients had symptomatic intracranial stenosis (anterior circulation, n = 40; posterior circulation, n = 60), presenting with recurrent transient ischemic attack or stroke under antithrombotic treatment. Mean degree of stenosis before treatment was 83 ± 13%. We assessed safety, defined as any stroke or death during the procedure and at 30 days follow-up, and technical success, defined as accurate delivery of the stent at the site of the target lesion.
Safety - periprocedural stroke or hemorrhage occurred in 11 patients treated with balloon-expandable stent, and in 14 of the patients treated with a self-expanding stent. One patient with a balloon-expandable stent died because of acute vessel rupture during treatment. One balloon-expandable stent and one self-expanding stent patient developed a severe reperfusion hemorrhage that resulted in death. Overall, the combined stroke and death rate at 30-day follow-up was 25·0% (23·9% for balloon-expandable stent group and 25·9% for the self-expanding stent group, P = 0·84). Technical success - intracranial angioplasty and stenting was technically successful in 96·3% of the self-expanding stent and 89·1% of the balloon-expandable stent patients (P = 0·31). Vascular complications were significantly less frequent in patients treated with a self-expanding stent (11·1%) than with a balloon-expandable stent (36·9%, P = 0·002).
Despite a high technical success, the rate of clinical adverse events at 30 days after intracranial angioplasty and stenting is high independently of the stent design. Thus, further development of intracranial stent systems and careful patient selection are mandatory.
在单中心系列研究中比较药物难治性颅内动脉粥样硬化性疾病患者行颅内血管成形术和支架置入术中使用球囊扩张支架和自膨式支架的安全性和技术成功率。
2000 年 4 月至 2009 年 9 月，100 例连续患者（平均年龄 64 岁，74%为男性）接受了 54 枚自膨式支架和 46 枚球囊扩张支架植入术。所有患者均存在症状性颅内狭窄（前循环 40 例，后循环 60 例），表现为抗血栓治疗下反复发作的短暂性脑缺血发作或卒中。治疗前狭窄程度平均为 83±13%。我们评估了安全性，定义为任何围手术期或 30 天随访期间发生的卒中或死亡；评估了技术成功率，定义为准确将支架输送至靶病变部位。
安全性——球囊扩张支架组 11 例患者和自膨式支架组 14 例患者出现围手术期卒中或出血。1 例球囊扩张支架患者在治疗过程中发生急性血管破裂死亡。1 例球囊扩张支架和 1 例自膨式支架患者发生严重再灌注出血，导致死亡。总的来说，30 天随访时的联合卒中死亡率为 25.0%（球囊扩张支架组 23.9%，自膨式支架组 25.9%，P=0.84）。技术成功率——96.3%的自膨式支架和 89.1%的球囊扩张支架患者颅内血管成形术和支架置入术技术成功（P=0.31）。自膨式支架组血管并发症发生率明显低于球囊扩张支架组（11.1%比 36.9%，P=0.002）。
尽管技术成功率较高，但颅内血管成形术和支架置入术后 30 天内临床不良事件的发生率仍较高，与支架设计无关。因此，需要进一步开发颅内支架系统和仔细选择患者。
