Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.
Vascular and Interventional Radiology Foundation Clinical Science Center, the Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.
Oper Neurosurg (Hagerstown). 2018 Feb 1;14(2):128-138. doi: 10.1093/ons/opx097.
Angioplasty and stenting is a recognized treatment option for patients with intracranial atherosclerosis.
To evaluate the long-term evolutionary luminal changes of intracranial atherosclerosis after angioplasty and stenting.
This was a retrospective study with patient consent. Eighty-two patients presenting with acute and minor cerebral ischemia due to stenosis ≥70%, who had received medical therapy with or without stenting (Wingspan), were invited. Luminal imaging was provided using 3-dimensional rotational angiography (3-DRA) at baseline and 12 mo, and cone-beam computed tomography angiography with intravenous contrast (CBCT) was provided at follow-up (median 82.4 mo [interquartile range 61.9-96.9 mo]).
Thirty-six patients in the stenting group and 26 patients in the medical group were recruited and completed the study. There was no statistically significant difference in demographics between the 2 patient groups. The luminal gain at 12 or 80 mo as compared to baseline in the stenting group was significantly greater than that in the medical group (12 mo: median gain 30% vs 7.2%, P < .001; 80 mo: median gain 42.9% vs 7.2%, P < .0001). Luminal loss or unchanged lumen was correlated with recurrent ischemic event. The differences in the stenosis degree assessment between CBCT and 3-DRA in the same 10 patients with or without stenting were 1.2 ± 0.6% or 0.2 ± 0.06%, respectively. There was a correlation between recurrent ischemic events and luminal loss.
Arterial lumen after angioplasty and stenting can probably be well maintained and delayed luminal gain does occur, long-term luminal loss is associated with recurrent ischemic events, CBCT might be useful as a less-invasive means for long-term assessment.
血管成形术和支架置入术是治疗颅内动脉粥样硬化患者的公认治疗选择。
评估血管成形术和支架置入术后颅内动脉粥样硬化的长期演变管腔变化。
这是一项回顾性研究，患者同意参与。我们邀请了 82 名因狭窄≥70%而出现急性和轻度脑缺血的患者，这些患者接受了药物治疗或支架置入治疗（Wingspan）。在基线和 12 个月时使用三维旋转血管造影（3-DRA）提供管腔成像，在随访时（中位数 82.4 个月[四分位距 61.9-96.9 个月]）使用静脉内对比剂的锥形束 CT 血管造影（CBCT）提供管腔成像。
支架组纳入 36 例患者，药物组纳入 26 例患者，两组患者均完成研究。两组患者的人口统计学特征无统计学差异。支架组与药物组相比，12 个月或 80 个月时的管腔获得量明显大于药物组（12 个月：中位数获得量 30%比 7.2%，P<0.001；80 个月：中位数获得量 42.9%比 7.2%，P<0.0001）。管腔损失或不变的管腔与复发性缺血事件相关。支架置入或未支架置入的 10 例患者的 CBCT 和 3-DRA 测量狭窄程度的差异分别为 1.2±0.6%或 0.2±0.06%。复发性缺血事件与管腔损失之间存在相关性。
血管成形术和支架置入术后的动脉管腔可能得到很好的维持，并且会出现延迟的管腔获得，长期的管腔损失与复发性缺血事件相关，CBCT 可能是一种有用的、侵袭性较小的长期评估手段。
