Farag Ehab, Abd-Elsayed Alaa, Anderson Michael, Abdelmalak Joseph, Schubert Armin
Departments of General Anesthesiology and Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
Ochsner J. 2012 Spring;12(1):30-4.
The bare metal self-expanding Wingspan stent (Boston Scientific, Natick, MA) was approved by the Food and Drug Administration under the Humanitarian Device Exemption in August 2005 for patients with intracranial atherosclerotic disease (ICAD) who are refractory to medical therapy. Relatively low rates of periprocedural morbidity and mortality have been reported.
After receiving institutional review board approval, we conducted a retrospective chart review to examine the anesthetic management and perioperative mortality and morbidity for all Wingspan stent insertions performed at our institution from 2005 to 2007.
A total of 72 patients with a history of intracranial stenosis had angioplasty and Wingspan stent insertion: 34 male and 38 female, with an average age of 64 ± 11.6 years. Preoperative systolic blood pressure was 200 ± 45 mmHg, and diastolic blood pressure was 100 ± 23 mmHg. All patients received general anesthesia for stent insertion. Five patients died (6.9%), 4 had perioperative stroke (5.5%), and 9 had recurrent stenosis (12.5%).
Anesthetic management for Wingspan stent insertion for ICAD is challenging. Maintenance of hemodynamic stability with optimum brain perfusion during the stent deployment is crucial to patient safety. A prospective study is warranted to assess the optimal anesthetic choice during Wingspan stent insertion.
裸金属自膨式Wingspan支架（波士顿科学公司，马萨诸塞州纳蒂克）于2005年8月获美国食品药品监督管理局批准，根据人道主义器械豁免条款用于药物治疗无效的颅内动脉粥样硬化疾病（ICAD）患者。据报道，围手术期发病率和死亡率相对较低。
获得机构审查委员会批准后，我们进行了一项回顾性病历审查，以检查2005年至2007年在本机构进行的所有Wingspan支架植入手术的麻醉管理以及围手术期死亡率和发病率。
共有72例有颅内狭窄病史的患者接受了血管成形术和Wingspan支架植入：男性34例，女性38例，平均年龄64±11.6岁。术前收缩压为200±45 mmHg，舒张压为100±23 mmHg。所有患者支架植入时均接受全身麻醉。5例患者死亡（6.9%），4例发生围手术期卒中（5.5%），9例出现再狭窄（12.5%）。
ICAD患者Wingspan支架植入的麻醉管理具有挑战性。在支架置入过程中维持血流动力学稳定并保证最佳脑灌注对患者安全至关重要。有必要进行一项前瞻性研究，以评估Wingspan支架植入期间的最佳麻醉选择。
