Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York 14203, USA.
Neurosurgery. 2012 Dec;71(6):1103-10. doi: 10.1227/NEU.0b013e318271bcb8.
The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study stopped recruiting patients because of higher-than-expected perioperative morbidity of primary stenting in patients with symptomatic intracranial stenosis. An alternative treatment, submaximal angioplasty without stenting, performed concurrently with SAMMPRIS, may offer revascularization benefits with a lower incidence of stenting-related risks.
To present the results of a consecutive case series of primary submaximal angioplasty procedures performed for symptomatic severe atherosclerotic intracranial stenosis refractory to medical treatment.
A database review identified primary submaximal angioplasty procedures performed in 41 patients for the treatment of >70% intracranial stenosis associated with an acute, symptomatic ischemic event in the distribution of the diseased vessel. For results analysis, 30-day events were reported as a percentage of patients treated. One-year periprocedural and ischemic event--free survival was reported as a percentage of all patients treated and displayed graphically with a Kaplan-Meier survival curve.
Three events in 41 patients included 1 intraprocedural vessel perforation, 1 reperfusion hemorrhage < 24 hours postoperatively, and 1 transient ischemic attack 3 months postprocedurally (30-day event rate, 2 of 41, 4.9%). Median clinical follow-up duration after submaximal angioplasty was 19 months, with ≥ 1 year of follow-up available for 32 patients. One-year perioperative and ischemic event-free survival was high (29 of 32 patients, 91%).
In this series, periprocedural safety of submaximal angioplasty in the setting of acute, symptomatic atherosclerotic intracranial stenosis was demonstrated. Although direct comparison is impossible because many patients were ineligible for stenting procedures, the complication profile compares favorably with rates of identically defined event-free survival for patients randomized to the medical (88%) and surgical (77%) arms of SAMMPRIS despite the absence of aggressive medical management.
由于症状性颅内狭窄患者原发性支架置入术围手术期发病率高于预期，支架置入和积极药物治疗预防颅内狭窄复发性卒中（SAMMPRIS）研究停止了患者招募。一种替代治疗方法是在 SAMMPRIS 中同时进行的亚最大限度血管成形术而不进行支架置入，可能具有更好的血管再通益处，同时支架相关风险的发生率较低。
介绍为治疗对药物治疗有反应的症状性严重动脉粥样硬化性颅内狭窄而进行的原发性亚最大限度血管成形术的连续病例系列结果。
通过数据库回顾，确定了 41 例患者因病变血管分布的急性、症状性缺血性事件而接受了>70%颅内狭窄的原发性亚最大限度血管成形术。对于结果分析，以接受治疗的患者百分比报告 30 天事件。以接受治疗的所有患者的百分比报告 1 年围手术期和缺血性事件无事件生存率，并通过 Kaplan-Meier 生存曲线进行图形显示。
41 例患者中有 3 例发生事件，包括 1 例术中血管穿孔、1 例术后<24 小时再灌注出血和 1 例 3 个月后出现短暂性脑缺血发作（30 天事件发生率为 2 例/41 例，4.9%）。亚最大限度血管成形术后的中位临床随访时间为 19 个月，32 例患者中有≥1 年的随访资料。1 年围手术期和缺血性事件无事件生存率较高（32 例患者中的 29 例，91%）。
在本系列中，急性、症状性动脉粥样硬化性颅内狭窄患者中，亚最大限度血管成形术的围手术期安全性得到了证实。尽管由于许多患者不符合支架置入术的条件，因此无法进行直接比较，但与 SAMMPRIS 中接受药物（88%）和手术（77%）治疗的手臂的无事件生存率定义相同的患者的并发症发生率相比，该并发症发生率具有可比性，尽管没有进行积极的药物治疗。
