Feng Zhengzhe, Duan Guoli, Zhang Ping, Chen Lei, Xu Yi, Hong Bo, Zhao Wenyuan, Liu Jianmin, Huang Qinghai
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, 200433, China.
BMC Neurol. 2015 Oct 8;15:187. doi: 10.1186/s12883-015-0443-9.
Wingspan stenting for the treatment of complex intracranial atherosclerotic stenosis (ICAS), i.e., that involving tortuous vascular pathways, long (>15 mm) lesions or arterial bifurcations, has a relatively high risk of complications. This retrospective study assessed the safety and efficacy of undersized balloon angioplasty followed by deployment of the more flexible Enterprise stent for the treatment of complex symptomatic ICAS.
Forty-four patients on combined antiplatelet therapy and intensive risk factor management and a symptomatic 70-99% stenosis of a major intracranial artery in complex settings that was treated with balloon angioplasty and Enterprise stent deployment between July 2009 and August 2013 were enrolled. Primary outcome was occurrence of ischemic or hemorrhagic stroke or death within 30 days after intervention. Secondary outcomes included procedural success (defined as achievement of <50% immediate residual stenosis), and follow-up clinical and angiographic outcomes.
With a procedural success rate of 100%, stenosis was reduced from 79.3 ± 8.1-14.9 ± 2.3%. Three (6.8%) ischemic and 1 (2.2%) hemorrhagic strokes occurred during the periprocedural period, with no further transient ischemic attacks or strokes in the 42 patients available at median 25.6 (range, 12-57) months follow-up. Of the 38 (86.4%) patients who underwent angiographic follow-up, 3 (6.81%) developed >50% in-stent restenosis after mean 22 months follow-up.
In this retrospective, single-center experience, undersized balloon angioplasty followed by Enterprise stent deployment appears technically feasible with a relatively low rate of complications for the treatment of complex symptomatic ICAS. Prospective, multicenter, randomized controlled trials against optimal medical management are warranted.
使用Wingspan支架治疗复杂颅内动脉粥样硬化性狭窄（ICAS），即涉及血管迂曲、长病变（>15mm）或动脉分叉的病变，并发症风险相对较高。本回顾性研究评估了使用尺寸偏小的球囊血管成形术，随后植入更灵活的Enterprise支架治疗复杂症状性ICAS的安全性和有效性。
纳入44例在2009年7月至2013年8月期间接受联合抗血小板治疗和强化危险因素管理，且在复杂情况下主要颅内动脉出现症状性70%-99%狭窄并接受球囊血管成形术和Enterprise支架植入的患者。主要结局是干预后30天内发生缺血性或出血性卒中或死亡。次要结局包括手术成功（定义为即刻残余狭窄<50%）以及随访的临床和血管造影结局。
手术成功率为100%，狭窄率从79.3±8.1%降至14.9±2.3%。围手术期发生3例（6.8%）缺血性卒中和1例（2.2%）出血性卒中，在中位随访25.6个月（范围12-57个月）时，42例患者中未再发生短暂性脑缺血发作或卒中。在38例（86.4%）接受血管造影随访的患者中，平均随访22个月后，3例（6.81%）出现支架内再狭窄>50%。
在这项回顾性单中心经验中，对于治疗复杂症状性ICAS，尺寸偏小的球囊血管成形术随后植入Enterprise支架在技术上似乎可行，并发症发生率相对较低。有必要开展针对最佳药物治疗的前瞻性、多中心、随机对照试验。
