Ueda Toshihiro, Takada Tatsuro, Nogoshi Shinji, Yoshie Tomohide, Takaishi Satoshi, Fukano Takayuki
Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Nakahara, Kawasaki.
Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Nakahara, Kawasaki.
J Stroke Cerebrovasc Dis. 2018 Jul;27(7):1870-1877. doi: 10.1016/j.jstrokecerebrovasdis.2018.02.019. Epub 2018 Mar 9.
A recent randomized controlled trial demonstrated that aggressive medical management was superior to angioplasty with stenting for intracranial stenosis. The purpose of this study was to assess initial and long-term outcomes of balloon angioplasty without stenting for symptomatic middle cerebral artery (MCA) stenosis.
We retrospectively analyzed the clinical data of 72 patients (mean age, 58.9 years old) with 84 balloon angioplasties without stenting for high-grade (>70%) atherosclerotic stenosis of the main trunk of the MCA. All patients had experienced recurrent transient ischemic attack or minor stroke resistant to medical treatment. We assessed perioperative and long-term outcomes such as restenosis and the recurrence of strokes. The follow-up period was a median of 63 months (range, 6-171 months).
Balloon angioplasty was successful in 97% of procedures. During the 30-day perioperative period, a total of 3 patients suffered from stroke (4.2%) without death. A total of 23 (31.9%) patients had restenosis at a time point that varied from 6 to 111 months. Diabetes mellitus (DM) was noted significantly more often in the restenosis group (39%) than in the nonrestenosis group (13%). Multivariate logistic regression analysis revealed DM (odds ratio, 4.84; 95% confidence interval, 1.196-19.62; P = .027) as an independent predictor of restenosis. Restenosis and DM were indicated as independent predictors of the recurrence of ischemic stroke and transient ischemic attack.
Balloon angioplasty without stenting for symptomatic MCA stenosis can be performed with a high successful rate and a low risk of complications. Long-term outcome data suggest that this procedure reduces the risk of further strokes.
最近一项随机对照试验表明，积极的药物治疗在颅内狭窄方面优于血管成形术加支架置入术。本研究的目的是评估无支架球囊血管成形术治疗症状性大脑中动脉（MCA）狭窄的初始和长期疗效。
我们回顾性分析了72例患者（平均年龄58.9岁）的临床资料，这些患者接受了84次无支架球囊血管成形术，用于治疗MCA主干的重度（>70%）动脉粥样硬化狭窄。所有患者均经历过复发性短暂性脑缺血发作或药物治疗无效的轻度中风。我们评估了围手术期和长期疗效，如再狭窄和中风复发情况。随访期中位数为63个月（范围6 - 171个月）。
97%的手术中球囊血管成形术成功。在30天围手术期内，共有3例患者发生中风（4.2%），无死亡病例。共有23例（31.9%）患者在6至111个月的不同时间点出现再狭窄。再狭窄组中糖尿病（DM）的发生率（39%）显著高于非再狭窄组（13%）。多因素逻辑回归分析显示DM（比值比，4.84；95%置信区间，1.196 - 19.62；P = 0.027）是再狭窄的独立预测因素。再狭窄和DM被认为是缺血性中风和短暂性脑缺血发作复发的独立预测因素。
无支架球囊血管成形术治疗症状性MCA狭窄成功率高，并发症风险低。长期疗效数据表明，该手术可降低进一步中风的风险。
