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中国东北地区症状性颅内椎基底动脉狭窄的支架置入术:一项单中心研究。

Stenting for Symptomatic Intracranial Vertebrobasilar Artery Stenosis in Northeast of China: A Single-Center Study.

作者信息

Wang Zhongxiu, Wang Chao, Li Chao, Shi Mingchao, Wang Shouchun, Yang Yi

机构信息

Department of Neurology, Stroke Center & Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China.

China National Comprehensive Stroke Center, Changchun, China.

出版信息

Front Neurol. 2021 Feb 16;11:609286. doi: 10.3389/fneur.2020.609286. eCollection 2020.

Abstract

We described the incidence of surgery-related complications to evaluate the safety of endovascular therapy for severe symptomatic intracranial vertebral basilar artery stenosis (IVBS) in our stroke center in Northeast of China. Consecutive patients with symptomatic IVBS caused by 70-99% stenosis despite standard medical treatment of antiplatelet agents plus statin were enrolled. Either balloon-mounted stent or balloon predilation plus self-expanding stent was performed. Clinical adverse events such as stroke, transient ischemic attack (TIA), and death after the surgery were documented. Radiological events such as in-stent thrombosis, dissection, and guide-wire perforation during the process were recorded as complications as well. The baseline characteristics and outcomes of patients among different Mori types were compared. From January 2017 to December 2018, 97 patients with stroke or TIA due to intracranial IVBS were treated by stenting, including 30 patients with basilar artery (BA) stenosis, 55 patients with intracranial vertebral artery (V4) stenosis, and 12 patients with V4-BA stenosis. The primary events include two intracranial hemorrhage (2.1%, 2/97), seven ischemic events (7.2%, 7/97), and two death (2.1%, 2/97). The successful stent deployment rate was 98.9% (96/97). The Apollo stents were used more for Mori A lesions. Self-expanding stents were more used in Mori C lesions. Mori C lesions were more vulnerable to endovascular procedure and showed higher rate of complications than A ( = 0.008) and B type ( = 0.047). A high technical success rate of IVBS stenting could be achieved, and the safety was acceptable, whereas Mori C lesions were more vulnerable to endovascular procedure and showed a higher rate of complications than A and B types.

摘要

我们描述了手术相关并发症的发生率,以评估在中国东北地区我们的卒中中心对症状性重度颅内椎基底动脉狭窄(IVBS)进行血管内治疗的安全性。纳入了尽管接受了抗血小板药物加他汀类药物的标准药物治疗,但仍因70%-99%狭窄导致症状性IVBS的连续患者。采用球囊扩张支架或球囊预扩张加自膨式支架治疗。记录术后的临床不良事件,如卒中、短暂性脑缺血发作(TIA)和死亡。过程中的放射学事件,如支架内血栓形成、夹层和导丝穿孔也被记录为并发症。比较了不同森类型患者的基线特征和结局。2017年1月至2018年12月,97例因颅内IVBS导致卒中或TIA的患者接受了支架置入治疗,其中基底动脉(BA)狭窄30例,颅内椎动脉(V4)狭窄55例,V4-BA狭窄12例。主要事件包括2例颅内出血(2.1%,2/97)、7例缺血性事件(7.2%,7/97)和2例死亡(2.1%,2/97)。支架成功置入率为98.9%(96/97)。Apollo支架在森A类病变中使用较多。自膨式支架在森C类病变中使用较多。森C类病变在血管内操作中更易发生并发症,其并发症发生率高于A类(P = 0.008)和B类(P = 0.047)。IVBS支架置入术可实现较高的技术成功率,安全性可接受,而森C类病变在血管内操作中更易发生并发症,其并发症发生率高于A类和B类。

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