From the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
AJNR Am J Neuroradiol. 2018 Aug;39(8):1487-1492. doi: 10.3174/ajnr.A5708. Epub 2018 Jul 5.
Although the Stenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study demonstrated a high incidence of perioperative complications for Intracranial Atherosclerotic disease (ICAD) treatments with stent placement, some studies have shown that submaximal angioplasty with an undersized balloon limits the risks of perioperative complications, suggesting that intervention may remain an alternative option for ICAD if perioperative complications are minimized. We sought to evaluate clinical and angiographic outcomes after primary angioplasty without stent placement in patients with symptomatic, high-grade intracranial stenosis and poor antegrade flow who were refractory to medical therapy.
All cases with high-grade, symptomatic intracranial stenosis and poor antegrade flow treated with intracranial angioplasty without stent placement at Xuanwu Hospital, Capital Medical University, from January 2010 to December 2016, were retrospectively reviewed. The main outcomes included the changes in antegrade flow and residual stenosis and any stroke or death within 1 month. We also evaluated functional outcomes, stroke, and restenosis in patients on follow-up.
Thirty-five patients (mean age, 64.3 years) were included, and the mean follow-up time was 9.7 months. The average preprocedural stenosis was 88.4%. The immediate, average postprocedure stenosis rate was 25.3%, and the average postprocedural stenosis rate at last angiographic follow-up was 34.7%. The primary end point of major stroke or death at 30 days was observed in 1 patient (1/35, 2.9%), and no patient had intraprocedural complications. The incidence of stroke or death at the last follow-up was 2.9%, which was superior to the results of the medical and stent-placement arms of the SAMMPRIS study. Severe restenosis was observed in 3 (3/25, 12%) patients but without any symptoms.
In this retrospective series, primary balloon angioplasty was an effective treatment option for symptomatic intracranial stenosis with a high risk of stroke.
尽管支架置入术与强化药物治疗预防颅内狭窄再发卒中（SAMMPRIS）研究表明颅内动脉粥样硬化性疾病（ICAD）治疗中支架置入术围手术期并发症发生率较高，但一些研究表明，次最大限度血管成形术和小尺寸球囊限制了围手术期并发症的风险，提示如果能将围手术期并发症最小化，介入治疗可能仍是 ICAD 的一种替代选择。我们旨在评估药物难治性症状性高分级颅内狭窄伴前向血流不良患者行单纯球囊扩张成形术的临床和血管造影结局。
回顾性分析首都医科大学宣武医院 2010 年 1 月至 2016 年 12 月期间接受单纯球囊扩张成形术而未置入支架治疗的症状性高分级颅内狭窄伴前向血流不良患者的病例资料。主要结局包括前向血流和残余狭窄的变化，以及 1 个月内任何卒中和死亡。我们还评估了随访患者的功能结局、卒中和再狭窄。
共纳入 35 例患者（平均年龄 64.3 岁），平均随访时间为 9.7 个月。术前狭窄平均为 88.4%。即刻狭窄率和平均术后狭窄率分别为 25.3%和 34.7%。30 天内主要终点事件（即重大卒中和死亡）为 1 例（1/35，2.9%），无术中并发症。末次随访时卒中和死亡的发生率为 2.9%，优于 SAMMPRIS 研究的药物和支架置入组的结果。3 例（3/25，12%）患者出现严重再狭窄，但无任何症状。
在本回顾性系列研究中，对于症状性颅内狭窄且卒中风险较高的患者，单纯球囊扩张成形术是一种有效的治疗选择。
