Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China.
J Clin Neurosci. 2013 Mar;20(3):362-6. doi: 10.1016/j.jocn.2012.03.033. Epub 2012 Dec 8.
The middle cerebral artery (MCA) is one of the most common sites of symptomatic intracranial atherosclerosis. We assessed the safety and efficacy of the Wingspan stent (Boston Scientific, Natick, MA, USA) for the treatment of symptomatic atherosclerotic MCA stenosis. Sixty-one patients with symptomatic MCA stenosis with narrowing of at least 70% among 61 patients were treated using Wingspan stents from March 2007 to December 2010. Clinical outcomes and imaging features were recorded and analyzed. The technical success rate was 98.4%. The rate of procedure-related complications during the periprocedural period (30 days) was 5.0% (three of 61 patients), which included one ischemic complication and two hemorrhagic complications with no permanent neurological sequelae. The mean degree of stenosis decreased from 76.8 ± 6.0% to 12.0 ± 11.5% following treatment. Forty-five patients (74%) were available for follow-up imaging with digital subtraction arteriography. In-stent restenosis (ISR) was documented in seven of these patients. A total of 61 patients were available for a clinical follow up. Four ischemic events (6.6%) occurred during the follow-up period, which were all transient ischemic attacks including two symptomatic ISR. The cumulative probability of an adverse event was 11.7% at 1 year. Of the 61 patients, 51 (83.6%) had their follow-up visit more than 12 months after the procedure, and no adverse events were found beyond 12 months after the procedure. Percutaneous transluminal angioplasty and stenting of the MCA was safe and associated with a low periprocedural complication rate. It may result in a good long-term benefit. Prospective randomized controlled trials and further long-term follow up are needed to provide more adequate statistical evidence to support our findings.
大脑中动脉（MCA）是症状性颅内动脉粥样硬化最常见的部位之一。我们评估了 Wingspan 支架（波士顿科学公司，马萨诸塞州纳提克）治疗症状性动脉粥样硬化性 MCA 狭窄的安全性和疗效。2007 年 3 月至 2010 年 12 月，61 例症状性 MCA 狭窄患者（61 例患者中至少有 70%狭窄）接受了 Wingspan 支架治疗。记录和分析了临床结果和影像学特征。技术成功率为 98.4%。围手术期（30 天）与手术相关的并发症发生率为 5.0%（61 例患者中有 3 例），包括 1 例缺血性并发症和 2 例出血性并发症，无永久性神经后遗症。治疗后狭窄程度从 76.8±6.0%平均降低至 12.0±11.5%。45 例（74%）患者接受了数字减影血管造影的随访影像学检查。其中 7 例患者有支架内再狭窄（ISR）。61 例患者可进行临床随访。随访期间发生 4 例缺血事件（6.6%），均为短暂性脑缺血发作，包括 2 例症状性 ISR。1 年时不良事件的累积发生率为 11.7%。61 例患者中，51 例（83.6%）在术后 12 个月以上进行了随访，术后 12 个月后未发现不良事件。MCA 的经皮腔内血管成形术和支架置入术是安全的，围手术期并发症发生率低。它可能带来良好的长期获益。需要前瞻性随机对照试验和进一步的长期随访，以提供更充分的统计证据支持我们的研究结果。
