Kim Kuk Seon, Hwang Dae Hyun, Ko Young Hwan, Kang Ik Won, Lee Eil Seong, Han You Mie, Min Sun Jung, Kim In Soo, Hur Choon Woong, Lui Shiyi, Lin Tong, You Tongfu, Shi Haibin, Li Linsun
Department of Radiology, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea.
Neurointervention. 2012 Feb;7(1):27-33. doi: 10.5469/neuroint.2012.7.1.27. Epub 2012 Feb 29.
We evaluated the usefulness of intracranial stent implantation for treating patients with atherosclerotic stenosis and with recurrent, ischemic, neurological symptoms despite having undergone medical therapy.
Between March 2004 and April 2010, we attempted intracranial, stent-assisted angioplasty in 77 patients with 85 lesions (anterior circulation 73 cases, posterior circulation 12 cases) and who had ischemic neurological symptoms with more than 50% major cerebral artery stenosis. We analyzed the results regarding the technical success rate, complication rate, and restenosis rate during the mean 29.4 month follow-up period.
Intracranial stent implantation was successfully performed in 74 cases (87.1%). In nine cases among the 11, failed cases, stent implantation failure was due to the tortuosity of the target vessel. One patient experienced middle cerebral artery rupture during the procedure, and we embolized the vessel using a microcoil. Five patients developed cerebral infarction in three weeks after the procedure, three of whom improved using conservative management, although the other, two patients expired. The mean number of residual stenoses decreased from 72.3% to 14.7%. Three patients demonstrated significant in-stent restenosis, i.e. more than 50%, during the follow-up period.
As stent-assisted angioplasty in intracranial, atherosclerotic stenosis is effective and relatively safe, it can be considered as an alternative treatment for patients with recurrent, ischemic, neurologic symptoms despite having undergone medical therapy.
我们评估了颅内支架植入术对于治疗尽管接受了药物治疗但仍有动脉粥样硬化狭窄且伴有复发性缺血性神经症状患者的有效性。
在2004年3月至2010年4月期间，我们对77例有85处病变（前循环73例，后循环12例）且大脑主要动脉狭窄超过50%并有缺血性神经症状的患者尝试进行颅内支架辅助血管成形术。我们分析了平均29.4个月随访期内的技术成功率、并发症发生率和再狭窄率结果。
74例（87.1%）成功进行了颅内支架植入。在11例失败病例中的9例，支架植入失败是由于靶血管迂曲。1例患者在手术过程中发生大脑中动脉破裂，我们使用微线圈栓塞了该血管。5例患者在术后三周发生脑梗死，其中3例采用保守治疗后病情改善，不过另外2例患者死亡。残余狭窄的平均比例从72.3%降至14.7%。3例患者在随访期内显示出明显的支架内再狭窄，即超过50%。
由于颅内动脉粥样硬化狭窄的支架辅助血管成形术有效且相对安全，对于尽管接受了药物治疗但仍有复发性缺血性神经症状的患者，可将其视为一种替代治疗方法。
