Lin Mao-Shih, Huang Chih-Wei, Tsuei Yuang-Seng
Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan.
Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Front Neurol. 2024 Mar 22;15:1348779. doi: 10.3389/fneur.2024.1348779. eCollection 2024.
The use of endovascular treatments for symptomatic intracranial atherosclerosis disease (ICAD) remains contentious due to high periprocedural complications. Many centers resort to general anesthesia for airway protection and optimal periprocedural conditions; however, this approach lacks real-time monitoring of patients' neurological status during procedures. In this study, we employed intracranial stenting with the Wingspan system under local anesthesia to address this challenge.
We conducted a retrospective study of 45 consecutive ICAD patients who underwent intracranial stenting with the Wingspan system at our hospital from August 2013 to May 2021. These stenting procedures were performed under local anesthesia in a hybrid operation room. Neurological assessments were conducted during the procedure. The patients with periprocedural complications were analyzed for the risk factors.
The study included 45 ICAD patients (median age 62 years; 35 male and 10 female individuals). Among them, 30 patients had anterior circulation ICAD, and 15 had posterior circulation ICAD. The periprocedural complication rate was 8.9% (4/45), with an overall mortality rate of 2.2% (1/45). Notably, no procedure-related perforation complications were found, and all ischemic complications occurred in the perforating bearing artery, specifically in patients with stents placed in the middle cerebral artery or basilar artery, while no complications were observed in the non-perforating bearing artery of the internal carotid artery and vertebral artery ( = 0.04).
Our study demonstrates the safety and efficacy of the Wingspan stent system when performed on selected patients under local anesthesia. This approach seems to reduce procedural-related morbidity and be a safe intervention. In addition, it is crucial for surgeons to be aware that patients with perforator-bearing artery stenosis may be at a higher risk of complications.
由于围手术期并发症发生率高，血管内治疗用于有症状的颅内动脉粥样硬化疾病（ICAD）仍存在争议。许多中心采用全身麻醉以保护气道并创造最佳的围手术期条件；然而，这种方法在手术过程中缺乏对患者神经状态的实时监测。在本研究中，我们采用局部麻醉下使用Wingspan系统进行颅内支架置入术来应对这一挑战。
我们对2013年8月至2021年5月在我院接受Wingspan系统颅内支架置入术的45例连续ICAD患者进行了回顾性研究。这些支架置入手术在复合手术室中局部麻醉下进行。手术过程中进行神经学评估。对围手术期出现并发症的患者分析危险因素。
该研究纳入45例ICAD患者（中位年龄62岁；男性35例，女性10例）。其中，30例患者为前循环ICAD，15例为后循环ICAD。围手术期并发症发生率为8.9%（4/45），总死亡率为2.2%（1/45）。值得注意的是，未发现与手术相关的穿孔并发症，所有缺血性并发症均发生在穿支供血动脉，特别是在大脑中动脉或基底动脉置入支架的患者中，而颈内动脉和椎动脉的非穿支供血动脉未观察到并发症（P = 0.04）。
我们的研究表明，在局部麻醉下对选定患者使用Wingspan支架系统是安全有效的。这种方法似乎能降低手术相关的发病率，是一种安全的干预措施。此外，外科医生必须意识到，穿支供血动脉狭窄的患者可能有更高的并发症风险。
