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Wingspan与Neuroform支架治疗大脑中动脉狭窄患者的安全性和有效性比较

A Comparison of Safety and Effectiveness Between Wingspan and Neuroform Stents in Patients With Middle Cerebral Artery Stenosis.

作者信息

Zhou Kai, Cao Yuan, He Xiao-Hui, Qiu Zhong-Ming, Liu Shuai, Gong Zi-Li, Shuai Jie, Yang Qing-Wu

机构信息

Department of Neurology, Xinqiao Hospital, Army Medical University, Chongqing, China.

出版信息

Front Neurol. 2021 May 20;12:527541. doi: 10.3389/fneur.2021.527541. eCollection 2021.

Abstract

Percutaneous transluminal angioplasty and stenting with the Wingspan stent has proven safe and effective in patients with middle cerebral artery stenosis (MCAS), but the off-label use of the Neuroform stent might be an alternative treatment. This study aimed to compare the safety and effectiveness of the above two intracranial stents in patients with MCAS. We retrospectively analyzed consecutive patients with symptomatic MCAS who had been treated with the Neuroform EZ or the Wingspan stent. A propensity score was generated to control for differences in baseline characteristics. The endpoints were the rate of peri-procedural complications within 30 days after stenting, the in-stent restenosis rate, and any target-vessel-related stroke or deaths during follow-up. After matching for propensity score, the peri-procedural complication rate in the Wingspan group was 7.4% compared with 5.6% in the Neuroform group ( = 1.00), while the follow-up in-stent restenosis rates were 23.3 vs. 14.3%, respectively ( = 0.41). In the restenosis group, the patients tended to be younger ( < 0.01) and the degree of artery stenosis before stenting was higher ( < 0.01). This study indicated that in patients with symptomatic MCAS, Neuroform EZ stents are an alternative to Wingspan. Moreover, younger age and higher degree of artery stenosis before stenting might be a risk factor of in-stent restenosis.

摘要

经皮腔内血管成形术及使用Wingspan支架进行支架置入术已被证明对大脑中动脉狭窄(MCAS)患者安全有效,但非适应证使用Neuroform支架可能是一种替代治疗方法。本研究旨在比较上述两种颅内支架在MCAS患者中的安全性和有效性。我们回顾性分析了连续接受Neuroform EZ或Wingspan支架治疗的有症状MCAS患者。生成倾向评分以控制基线特征的差异。终点指标为支架置入后30天内的围手术期并发症发生率、支架内再狭窄率以及随访期间任何与靶血管相关的卒中或死亡情况。在对倾向评分进行匹配后,Wingspan组的围手术期并发症发生率为7.4%,而Neuroform组为5.6%(P = 1.00),而随访期间的支架内再狭窄率分别为23.3%和14.3%(P = 0.41)。在再狭窄组中,患者往往更年轻(P < 0.01)且支架置入前动脉狭窄程度更高(P < 0.01)。本研究表明,对于有症状的MCAS患者,Neuroform EZ支架可作为Wingspan支架的替代选择。此外,年龄较小和支架置入前动脉狭窄程度较高可能是支架内再狭窄的危险因素。

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