Möhlenbruch Markus A, Pfaff Johannes, Herweh Christian, Bösel Julian, Rizos Timolaos, Nagel Simon, Ringleb Peter A, Bendszus Martin, Pham Mirko
Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany.
Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
Neuroradiology. 2016 Sep;58(9):893-9. doi: 10.1007/s00234-016-1716-8. Epub 2016 Jun 16.
We present a novel endovascular technique to treat intracranial atherosclerotic stenosis (ICS) with the specific potential to reduce the procedure-related complications which so far limited safety and efficacy of endovascular ICS intervention.
Six consecutive patients were included in this study with the following criteria of inclusion: (1) failure of dual antiplatelet therapy defined as recurrent TIA or ischemic stroke, (2) presence of ICS of ≥70 %, and (3) endovascular accessibility of the target lesion as judged by CTA or MRA. Technical feasibility, safety, and efficacy were observed for the first-ballon-then-stent (FBTS) technique using the percutaneous transluminal angioplasty (PTA) balloon microcatheter over which a self-expandable microstent can be directly delivered obviating the need to exchange microcatheters.
FBTS was performed in six patients (four female, median age 69, median stenosis 82.5 %) all refractory to best medical treatment: three V4, two M1, and one supraclinoid ICA stenosis. PTA and stent deployment were technically feasible in all patients and immediately effective with a median postprocedural stenosis grade of 10 %. Angiographic and clinical safety measures were met with no occult or clinically evident hemorrhage or ischemic complications (four patients discharged without alteration in mRS, two patients with significant clinical improvement). No occurrence of TIA, stroke, or death was observed during follow-up.
The FBTS method in this series appeared to be safe and effective for the endovascular treatment of ICS. It bears the specific potential to reduce wire perforations, which so far have been linked to major procedure-related adverse events of endovascular ICS treatment.
我们提出一种新型血管内技术来治疗颅内动脉粥样硬化狭窄（ICS），该技术具有降低手术相关并发症的特定潜力，而这些并发症迄今为止限制了血管内ICS干预的安全性和有效性。
本研究纳入了连续6例患者，纳入标准如下：（1）双重抗血小板治疗失败，定义为复发性短暂性脑缺血发作（TIA）或缺血性卒中；（2）存在≥70%的ICS；（3）经CTA或MRA判断目标病变可通过血管内途径到达。观察使用经皮腔内血管成形术（PTA）球囊微导管的先球囊后支架（FBTS）技术的技术可行性、安全性和有效性，在该微导管上可直接输送自膨胀微支架，无需更换微导管。
6例患者（4例女性，中位年龄69岁，中位狭窄率82.5%）均接受了FBTS治疗，这些患者对最佳药物治疗均无效：3例为V4段狭窄，2例为M1段狭窄，1例为床突上段颈内动脉狭窄。PTA和支架置入在所有患者中技术上均可行，且立即有效，术后中位狭窄分级为10%。血管造影和临床安全指标均达标，未发生隐匿性或临床明显的出血或缺血性并发症（4例患者出院时改良Rankin量表（mRS）评分无变化，2例患者临床有显著改善）。随访期间未观察到TIA、卒中或死亡事件。
本系列中的FBTS方法似乎对ICS的血管内治疗安全有效。它具有降低导丝穿孔的特定潜力，而导丝穿孔迄今为止一直与血管内ICS治疗的主要手术相关不良事件有关。
