Li Guangwen, Wang Naidong, Li Xin, Ma Ning, Liu Tonghui, Sun Yujie, Liu Peng, Miao Zhongrong, Zhang Yong
Department of Neurology and Interventional Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
World Neurosurg. 2019 Apr;124:e675-e681. doi: 10.1016/j.wneu.2018.12.189. Epub 2019 Jan 16.
To compare the technical and 1-year clinical outcome in balloon-mounted versus self-expanding stenting for symptomatic severe stenosis of the middle cerebral artery combined with poor collaterals in China.
Ninety-one patients with severe middle cerebral artery atherosclerotic stenosis combined with poor collaterals were recruited in the study. Balloon-mounted stent or self-expanding stent were selected to treat patients following a guideline. The baseline characteristics, cerebral angiography, and outcomes were compared between the patients treated with balloon-mounted stent and self-expanding stent.
The mean degree of stenosis was 85.5% ± 6.37% in the balloon-mounted stenting group and 85.4% ± 7.73% in the self-expanding stenting group before treatment (P = 0.930). A longer operative time occurred in patients treated with self-expanding stent than in those treated with balloon-mounted stent (96.7 vs. 68.6 minutes, respectively; P = 0.002). Patients with self-expanding stent had a higher rate of residual stenosis than those with balloon-mounted stent (67.3% vs. 38.9%, respectively; P = 0.014). The patients in balloon-mounted stenting group was less likely to have restenosis (6.1% vs. 26.5%, P = 0.019) and had a lower degree of stenosis (5.0% ± 0.0% vs. 26.9% ± 29.2%, P = 0.019) compared with patients in the self-expanding stenting group. During the 1-year follow-up, the recurrence rate of ischemic stroke, transient ischemic attack, hemorrhage stroke, and death was not significantly different between the 2 groups (1/33 vs. 2/49, P = 0.804; 1/33 vs. 1/49, P = 0.776; 0/33 vs. 2/49, P = 0.240; 1/33 vs. 0/49, P = 0.220, respectively).
Balloon-mounted stents may have a shorter operative time and lower restenosis occurrence than self-expanding stents. No significant difference in 1-year outcome was observed between the 2 groups.
比较球囊扩张式支架与自膨式支架治疗中国症状性大脑中动脉严重狭窄合并侧支循环不良的技术及1年临床疗效。
本研究纳入91例大脑中动脉严重动脉粥样硬化狭窄合并侧支循环不良的患者。按照指南选择球囊扩张式支架或自膨式支架治疗患者。比较球囊扩张式支架组和自膨式支架组患者的基线特征、脑血管造影及疗效。
治疗前，球囊扩张式支架组平均狭窄程度为85.5%±6.37%，自膨式支架组为85.4%±7.73%（P = 0.930）。自膨式支架治疗患者的手术时间比球囊扩张式支架治疗患者长（分别为96.7分钟和68.6分钟；P = 0.002）。自膨式支架患者的残余狭窄率高于球囊扩张式支架患者（分别为67.3%和38.9%；P = 0.014）。与自膨式支架组患者相比，球囊扩张式支架组患者再狭窄可能性较小（6.1%对26.5%，P = 0.019），且狭窄程度较低（5.0%±0.0%对26.9%±29.2%，P = 0.019）。在1年随访期间，两组缺血性卒中、短暂性脑缺血发作、出血性卒中和死亡的复发率无显著差异（分别为1/33对2/49，P = 0.804；1/33对1/49，P = 0.776；0/33对2/49，P = 0.240；1/33对0/49，P = 0.220）。
球囊扩张式支架的手术时间可能比自膨式支架短，再狭窄发生率更低。两组1年疗效无显著差异。
