Department of Neurology, University of California, Irvine, California, USA.
New Era Stroke Care and Research Institute, The Rocket Force General Hospital, Beijing, China.
Stroke Vasc Neurol. 2018 Jun 18;3(3):140-146. doi: 10.1136/svn-2018-000158. eCollection 2018 Sep.
Intracranial stenosis is a common cause of ischaemic strokes, in particular, in the Asian, African and Hispanic populations. The randomised multicentre study Stenting and Aggressive Medical Management for the Prevention of Recurrent stroke in Intracranial Stenosis (SAMMPRIS) showed 14.7% risk of stroke or death in the stenting group versus 5.8% in the medical group at 30 days, and 23% in the stenting group versus 15% in the medical group at a median follow-up of 32.4 months. The results demonstrated superiority of medical management over stenting and have almost put the intracranial stenting to rest in recent years. Of note, 16 patients (7.1%) in the stenting group had disabling or fatal stroke within 30 days mostly due to periprocedural complications as compared with 4 patients (1.8%) in the medical group. In contrast, 5 patients (2.2%) in the stenting group and 14 patients (6.2%) in the medical group had a disabling or fatal stroke beyond 30 days, indicating significant benefit of stenting if periprocedural complications can be reduced. Recently, the results of the Chinese Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis trial and the Wingspan Stent System Post Market Surveillance Study (WEAVE trial) showed 2%-2.7% periprocedural complications. It is time to evaluate the role of intracranial stenting for the prevention of disabling or fatal stroke.
颅内狭窄是缺血性中风的一个常见原因，特别是在亚洲、非洲和西班牙裔人群中。随机多中心研究支架置入术和强化药物治疗预防颅内狭窄复发性卒中（SAMMPRIS）显示，支架置入组在 30 天内的卒中或死亡风险为 14.7%，而药物治疗组为 5.8%；支架置入组在中位随访 32.4 个月时的卒中或死亡风险为 23%，而药物治疗组为 15%。研究结果表明药物治疗优于支架置入，并在近年来几乎使颅内支架置入术处于停滞状态。值得注意的是，支架置入组中有 16 名患者（7.1%）在 30 天内发生致残性或致死性卒中，主要是由于围手术期并发症，而药物治疗组中仅有 4 名患者（1.8%）。相比之下，支架置入组中有 5 名患者（2.2%）和药物治疗组中有 14 名患者（6.2%）在 30 天后发生致残性或致死性卒中，表明如果能减少围手术期并发症，支架置入具有显著获益。最近，中国血管成形术和支架置入治疗症状性颅内严重狭窄试验以及 Wingspan 支架系统上市后监测研究（WEAVE 试验）的结果显示围手术期并发症为 2%-2.7%。现在是评估颅内支架置入术预防致残性或致死性卒中作用的时候了。
