Dan Bitang, Zhu Bifeng, Zeng Wei, Peng Tao, Liu Jing, Li Xin, Zhang Junjian
Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, People's Republic of China.
Department of Neurology, The Third People's Hospital of Hubei Province, Jianghan University, Wuhan, Hubei, People's Republic of China.
J Neurol Surg B Skull Base. 2023 Sep 27;85(5):481-488. doi: 10.1055/s-0043-1774791. eCollection 2024 Oct.
This study reported a single-center clinical trial of endovascular treatment for symptomatic nonacute occlusion of the intracranial large artery (NA-ILAO). The aim of this study was to evaluate the safety, feasibility, and clinical effect of simple balloon dilatation and stent implantation. The patients diagnosed with symptomatic NA-ILAO were enrolled. A total of 40 cases were included in this study. While recanalization failed in 4 patients, it was successful in 36 patients, who were then divided into two groups for further analysis: balloon dilatation group ( = 24) and stent implantation group ( = 12). The perioperative complications, clinical outcome, and follow-up results were analyzed. Perioperative complications in the stent implantation group were significantly higher than those in the simple balloon dilatation group ( < 0.05). There were 21 and 10 cases of 90-day good clinical outcome (modified Rankin scale [mRS] ≤ 2) in the balloon and stent groups, respectively ( = 0.518). All patients with successful recanalization underwent digital subtraction angiography (DSA) or CT angiography (CTA) during an average follow-up of 14 months. There were two cases of restenosis in the balloon dilatation group and one in the stent implantation group ( = 1.000). There were two cases of re-occlusion in the stent group and none in the balloon dilatation group ( < 0.001). Stroke recurred in two cases in the stent group and in one case in the simple balloon dilatation group ( = 0.013). Endovascular recanalization is safe and feasible for patients with symptomatic NA-ILAO. Compared with stent implantation, simple balloon dilation may be a better recanalization method, but larger randomized controlled trials are needed to confirm it.
本研究报告了一项针对症状性颅内大动脉非急性闭塞（NA-ILAO）的血管内治疗的单中心临床试验。本研究的目的是评估单纯球囊扩张和支架植入的安全性、可行性及临床效果。招募了诊断为症状性NA-ILAO的患者。本研究共纳入40例患者。4例患者再通失败，36例成功，成功的患者被分为两组进行进一步分析：球囊扩张组（n = 24）和支架植入组（n = 12）。分析了围手术期并发症、临床结局及随访结果。支架植入组的围手术期并发症显著高于单纯球囊扩张组（P < 0.05）。球囊组和支架组分别有21例和10例患者在90天时临床结局良好（改良Rankin量表[mRS]≤2）（P = 0.518）。所有再通成功的患者在平均14个月的随访期间均接受了数字减影血管造影（DSA）或CT血管造影（CTA）。球囊扩张组有2例再狭窄，支架植入组有1例（P = 1.000）。支架组有2例再闭塞，球囊扩张组无（P < 0.001）。支架组有2例卒中复发，单纯球囊扩张组有1例（P = 0.013）。血管内再通对于症状性NA-ILAO患者是安全可行的。与支架植入相比，单纯球囊扩张可能是更好的再通方法，但需要更大规模的随机对照试验来证实。
