中国卒中杂志 ›› 2017, Vol. 12 ›› Issue (07): 592-597.DOI: 10.3969/j.issn.1673-5765.2017.07.006

• 论著 • 上一篇    下一篇

Enterprise支架治疗复杂症状性颅内动脉粥样硬化性狭窄

刘恋,马宁,莫大鹏,高峰,徐晓彤,宋立刚,孙瑄,王博,霍晓川,缪中荣   

  1. 100050 北京首都医科大学附属北京天坛医院脑血管病中心,介入神经病学科
  • 收稿日期:2017-04-11 出版日期:2017-07-20 发布日期:2017-07-20
  • 通讯作者: 缪中荣 zhongrongm@163.com

Enterprise Stent in Treatment of Symptomatic Complex Intracranial Atherosclerotic Stenosis

  • Received:2017-04-11 Online:2017-07-20 Published:2017-07-20

摘要:

目的 评估Enterprise支架治疗复杂症状性颅内动脉粥样硬化性狭窄(intracranial atherosclerotic stenosis,ICAS)的安全性和有效性。 方法 收集2014年1月-2016年6月首都医科大学附属北京天坛医院介入神经病学科收治的24例复杂 症状性I CAS[如路径迂曲,病变长(>15 mm),病变接近分叉,狭窄合并动脉瘤等]并经亚满意球囊扩张 +Enterprise支架治疗的患者资料。主要终点事件定义为支架术后30 d内任何卒中(包括缺血性和出血 性)、短暂性脑缺血发作(transient ischemic attack,TIA)或者死亡。次要终点事件为支架治疗成功;随 访期间>50%的支架内再狭窄或者靶血管供血区的卒中或TIA。 结果 24例入组患者中,主要终点事件发生率为4.2%(1/24),表现为无症状性蛛网膜下腔出血 (subarachnoid hemorrhage,SAH),无缺血性并发症发生。支架治疗技术成功率为100%,血管狭窄率从 (87.1±9.3)%降为(17.5±8.7)%。4枚狭窄附近动脉瘤同时栓塞。共18例患者进行了影像学随访,6例 患者(33.3%)发生了支架内再狭窄。其中3例患者为症状性再狭窄并进行了支架内球囊扩张。 结论 亚满意球囊扩张+Enterprise支架置入治疗颅内复杂动脉粥样硬化性狭窄技术可行,具有较低 并发症。经导管释放的支架可能提高支架治疗的安全性。

文章导读: 由于Enterprise支架固有优点,亚满意球囊扩张+Enterprise支架置入治疗复杂的颅内动脉狭窄有其优势,但是其治疗后再狭窄率可能需要大样本观察。

关键词: 颅内动脉狭窄; 介入治疗; Enterprise支架; 血管成形

Abstract:

Objective To assess the feasibility and efficacy of Enterprise stent using in treatment of Symptomatic Complex Intracranial Atherosclerotic Stenosis (ICAS). Methods The data of 24 patients with symptomatic severe stenosis of a major intracranial artery refractory to aggressive medical therapy were treated by undersized balloon angioplasty and Enterprise stent deployment from January 2014 to June 2016 were collected. All the lesions were considered as complex ICAS, i.e. with tortuous access, long (>15 mm) lesions and/or arterial bifurcations, or with concurrent aneurysms near the stenotic lesion. The primary outcome was defined any stroke (including ischemic or hemorrhagic), transient ischemic attack (TIA) or deaths after stenting procedure within 30 days. The secondary outcome was successful revascularization; occurrence of >50% in-stent restenosis; or occurrence of TIA or stroke attributable to the target vessel during the follow-up. Results Of the 24 patients included, the 30-day stroke, TIA or death was 4.2% (1/24), which presented as asymptomatic subarachnoid hemorrhage (SAH). There was no ischemic complications occurred during or after procedures (0%) in this cohort. The procedural success rate of 100 %, and stenosis was reduced from (87.1±9.3)% to (17.5±8.7)%. Four concurrent aneurysms were embolized simultaneously. Eighteen patients underwent imaging follow-up and 6 patients (33.3%) developed in-stent restenosis (ISR) during 6-month angiographic follow-up. Among which, 3 patients had symptomatic restenosis and underwent in-stent ballon angioplasty. Conclusion In this study, undersized balloon angioplasty followed by Enterprise stent deployment appears technically feasibility with a relatively low rate of complications for the treatment of ICAS. Stent with catheter-delivery might promote the procedural safety.

Key words: Intracranial stenosis; Intervention therapy; Enterprise stent; Angioplasty