远端球囊血管成形术治疗脑血管痉挛可降低迟发性脑梗死的风险。
Distal Balloon Angioplasty of Cerebral Vasospasm Decreases the Risk of Delayed Cerebral Infarction.
机构信息
From the Departments of Interventional Neuroradiology (M.-A.L., A.Z., J.B., J.-P.S.-M., V.C., E.H.)
EA 7334 REMES (M.-A.L., E.H.), L'Université Paris Diderot, Paris, France.
出版信息
AJNR Am J Neuroradiol. 2019 Aug;40(8):1342-1348. doi: 10.3174/ajnr.A6124. Epub 2019 Jul 18.
BACKGROUND AND PURPOSE
Conventional angioplasty of cerebral vasospasm combines proximal balloon angioplasty (up to the first segment of cerebral arteries) with chemical angioplasty for distal arteries. Distal balloon angioplasty (up to the second segment of cerebral arteries) has been used in our center instead of chemical angioplasty since January 2015. We aimed to assess the effect of this new approach in patients with aneurysmal SAH.
MATERIALS AND METHODS
The occurrence, date, territory, and cause of any cerebral infarction were retrospectively determined and correlated to angioplasty procedures. Delayed cerebral infarction, new angioplasty in the territory of a previous angioplasty, angioplasty complications, 1-month mortality, and 6- to 12-month modified Rankin Scale ≤ 2 were compared between 2 periods (before-versus-after January 2015, from 2012 to 2017) with adjustment for age, sex, World Federation of Neurosurgical Societies score, and the modified Fisher grade.
RESULTS
Three-hundred-ninety-two patients were analyzed (160 before versus 232 after January 2015). Distal balloon angioplasty was associated with the following: higher rates of angioplasty (43% versus 27%, < .001) and intravenous milrinone (31% versus 9%, < .001); lower rates of postangioplasty delayed cerebral infarction (2.2% versus 7.5%, = .01) and new angioplasty (8% versus 19%, = .003) independent of the rate of patients treated by angioplasty and milrinone; and the same rates of stroke related to angioplasty (3.6% versus 3.1%, = .78), delayed cerebral infarction (7.7% versus 12.5%, = .12), mortality (10% versus 11%, = .81), and favorable outcome (79% versus 73%, = .21).
CONCLUSIONS
Our study suggests that distal balloon angioplasty is safe and decreases the risk of delayed cerebral infarction and the recurrence of vasospasm compared with conventional angioplasty. It fails to show a clinical benefit possibly because of confounding changes in adjuvant therapies of vasospasm during the study period.
背景与目的
传统的脑血管痉挛血管成形术将近端球囊血管成形术（直至大脑动脉的第一段）与远端动脉的化学血管成形术相结合。自 2015 年 1 月以来，我们中心已将远端球囊血管成形术（直至大脑动脉的第二段）用于代替化学血管成形术。我们旨在评估该新方法在伴有动脉瘤性蛛网膜下腔出血的患者中的效果。
材料和方法
回顾性确定任何脑梗死的发生、日期、部位和原因，并与血管成形术程序相关联。在两个时期（2012 年至 2017 年与 2015 年 1 月以后）之间，比较延迟性脑梗死、在先前血管成形术部位的新血管成形术、血管成形术并发症、1 个月死亡率和 6 至 12 个月改良 Rankin 量表评分≤2，并对年龄、性别、世界神经外科学会评分和改良 Fisher 分级进行调整。
结果
分析了 392 例患者（160 例在 2015 年 1 月之前，232 例在 2015 年 1 月之后）。远端球囊血管成形术与以下因素相关：血管成形术（43%比 27%， <.001）和静脉注射米力农（31%比 9%， <.001）的发生率较高；血管成形术后迟发性脑梗死（2.2%比 7.5%， =.01）和新血管成形术（8%比 19%， =.003）的发生率较低，与接受血管成形术和米力农治疗的患者比例无关；与血管成形术相关的卒中发生率（3.6%比 3.1%， =.78）、迟发性脑梗死（7.7%比 12.5%， =.12）、死亡率（10%比 11%， =.81）和良好结局（79%比 73%， =.21）相似。
结论
我们的研究表明，与传统血管成形术相比，远端球囊血管成形术安全且降低了迟发性脑梗死和血管痉挛复发的风险。由于研究期间血管痉挛辅助治疗的混杂变化，该方法可能未能显示出临床获益。
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