Karanam Lakshmi Sudha Prasanna, Sharma Mukesh, Alurkar Anand, Baddam Sridhar Reddy, Pamidimukkala Vijaya, Polavarapu Raghavasarma
Lalitha Super Speciality Hospital, Guntur, Andhra Pradesh, India.
Apollo Hospitals, Ahmedabad, Gujarat, India.
J Vasc Interv Neurol. 2017 Jun;9(4):29-34.
To evaluate the role and efficacy of the balloon angioplasty in intracranial atherosclerotic disease (ICAD) in patients who presented with acute stroke due to vessel occlusion and in patients with symptomatic disease despite optimum medical management.
From 2013 to 2016, a total of 39 patients (24 males and 15 females with a mean age of 64.5 years) underwent balloon angioplasty over a period of 2 years and 8 months in three different institutions in India. Maverick balloon catheter (Boston scientific) is used in all the patients. MRI brain with MR angiogram was done in all the patients prior to intervention. Twenty-three patients who had underlying severe ICAD presented with acute stroke due to vessel occlusion. Sixteen patients presented with symptomatic ICAD with recurrent ischemic attack due to the progressing underlying disease despite optimum medical management. Technical success, peri-procedural events, and clinical outcomes were documented for all the patients.
Technical success (residual stenosis < 50%) was achieved in 37 cases. Extra cranial carotid stenting was required in 2 patients. In patients with acute stroke presentation (NIHSS score median of 16.5), adjuvant intravenous and intra-arterial tissue plasminogen activator were given in 8 and 3 patients, respectively, and mechanical thrombectomy (MT) with solitaire was used in 15 patients. Patients who underwent MT in acute stroke without ICAD were not included in the study. Reocclusion occurred in one patient who developed disabling stroke and one patient died of intra-cerebral hemorrhage. Thus, the mortality of this study is 2%. Clinical outcome was assessed based on mRS. One-month, three-month, and six-month follow-up was available in >90% of the patients. MR angiogram on follow-up of nine months was done in 26 patients, and none of them had restenosis.
Balloon angioplasty is a safe option and can be effectively used in patients of ICAD with acceptable risks and promising outcomes.
评估球囊血管成形术在因血管闭塞导致急性卒中的颅内动脉粥样硬化疾病（ICAD）患者以及尽管接受了最佳药物治疗但仍患有症状性疾病的患者中的作用和疗效。
2013年至2016年期间，印度三家不同机构在2年零8个月的时间里，共有39例患者（24例男性和15例女性，平均年龄64.5岁）接受了球囊血管成形术。所有患者均使用了Maverick球囊导管（波士顿科学公司）。所有患者在干预前均进行了头颅MRI及磁共振血管造影。23例患有严重ICAD的患者因血管闭塞出现急性卒中。16例患者因潜在疾病进展，尽管接受了最佳药物治疗，但仍出现症状性ICAD并伴有复发性缺血性发作。记录了所有患者的技术成功率、围手术期事件和临床结局。
37例患者实现了技术成功（残余狭窄<50%）。2例患者需要进行颅外颈动脉支架置入术。在急性卒中患者（美国国立卫生研究院卒中量表[NIHSS]评分中位数为16.5）中，分别有8例和3例患者接受了辅助静脉和动脉内组织纤溶酶原激活剂治疗，15例患者使用了Solitaire进行机械取栓（MT）。急性卒中但无ICAD且接受MT的患者未纳入本研究。1例患者发生致残性卒中后出现再闭塞，1例患者死于脑出血。因此，本研究的死亡率为2%。基于改良Rankin量表（mRS）评估临床结局。超过90%的患者进行了1个月、3个月和6个月的随访。26例患者在9个月随访时进行了磁共振血管造影，均未出现再狭窄。
球囊血管成形术是一种安全的选择，可有效用于具有可接受风险且预后良好的ICAD患者。
