[1]王震宇,蒋业清,黄 磊,等.Wingspan支架治疗颅内动脉狭窄有效性和安全性的单中心研究[J].介入放射学杂志,2020,29(08):748-752.
 WANG Zhenyu,JIANG Yeqing,HUANG Lei,et al.The effectiveness and safety of Wingspan stenting for intracranial artery stenosis: a single- center study[J].journal interventional radiology,2020,29(08):748-752.
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Wingspan支架治疗颅内动脉狭窄有效性和安全性的单中心研究()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
29
期数:
2020年08
页码:
748-752
栏目:
神经介入
出版日期:
2020-08-25

文章信息/Info

Title:
The effectiveness and safety of Wingspan stenting for intracranial artery stenosis: a single- center study
作者:
王震宇 蒋业清 黄 磊 葛 亮 张晓龙
Author(s):
WANG Zhenyu JIANG Yeqing HUANG Lei GE Liang
ZHANG Xiaolong. Department of Radiology, Affiliated Huashan Hospital, Fudan University, Shanghai 200040, China
关键词:
【关键词】 颅内动脉狭窄 术后即刻残余狭窄率 有效性 安全性
文献标志码:
A
摘要:
【摘要】 目的 探讨颅内动脉狭窄血管内治疗的安全性和有效性,以及术后即刻残余狭窄率与远期临床预后的相关性。方法 回顾性分析2014年1月至2018年6月在复旦大学附属华山医院接受Wingspan支架治疗的59例(62处)颅内动脉狭窄患者。评价手术技术成功率、手术前后血管狭窄率、手术相关并发症及转归。比较术后即刻高残余狭窄率组(>30%)和低残余狭窄率组(≤30%)手术相关并发症及临床预后的差异。 结果 手术技术成功率为93.5%(58/62)。术后即刻残余狭窄率为(22.5±9.7)%,较术前(60.8±7.8)%明显改善(P<0.001)。发生手术相关并发症6例(10.2%,6/59),其中术中出血2例,血栓形成1例,夹层形成2例,术后再灌注损伤出血1例;5例术中并发症患者出院时改良Rankin量表(mRS)评分未增加,1例术后再灌注损伤患者病情稳定后转外院康复治疗。53例患者(89.8%,53/59)获平均(18±14)个月临床随访,随访时平均mRS评分(0.83±1.40)分较入院时(1.63±0.98)分显著改善(P<0.01);平均Barthel指数评分(87±17)分较入院时(69±20)分显著升高(P<0.001)。51处狭窄病变(82.3%,51/62)获平均(15±13)个月影像学随访,3处(5.88%,3/51)出现支架内再狭窄(ISR),其中1处(1.96%,1/51)再治疗。与术后即刻低残余狭窄率组相比,高残余狭窄率组中更多见椎-基底动脉汇合处狭窄患者(P<0.05)、高术中并发症率患者(P<0.05)和高手术风险患者(P=0.08)。但两组远期随访mRS评分和日常生活活动能力等级差异无统计学意义。 结论 Wingspan支架治疗颅内动脉狭窄安全有效。术后即刻高残余狭窄率可能与椎- 基底动脉汇合处狭窄、高手术风险、高术中并发症发生率相关,但并不能作为预测血管内治疗远期临床预后的预测指标。

参考文献/References:


[1] Alexander MJ, Zauner A, Chaloupka JC, et al. WEAVE trial: final results in 152 on- label patients[J]. Stroke, 2019, 50: 889- 894.
[2] 陈 茹,张念军,赵 敏,等. 支架与药物治疗症状性颅内动脉狭窄远期疗效对比[J]. 介入放射学杂志, 2016, 25:97- 101.
[3] Stayman AN, Nogueira RG, Gupta R. A systematic review of stenting and angioplasty of symptomatic extracranial vertebral artery stenosis[J]. Stroke, 2011, 42: 2212- 2216.
[4] 症状性颅内动脉粥样硬化性狭窄血管内治疗专家共识组. 症状性颅内动脉粥样硬化性狭窄血管内治疗中国专家共识[J]. 中华内科杂志, 2013, 52:271- 275.
[5] Wang ZL, Gao BL, Li TX, et al. Symptomatic intracranial vertebral artery atherosclerotic stenosis(≥70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting[J]. Eur J Radiol, 2015, 84: 1801- 1804.
[6] 蔡栋阳,王子亮,李天晓,等. 单中心Wingspan支架治疗大脑中动脉严重狭窄的长期随访结果[J]. 中华放射学杂志, 2014,48:674- 677.
[7] Bose A, Hartmann M, Henkes H, et al. A novel, self- expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study[J]. Stroke, 2007, 38: 1531- 1537.
[8] Zaidat OO, Klucznik R, Alexander MJ, et al. The NIH registry on use of the Wingspan stent for symptomatic 70%- 99% intracranial arterial stenosis[J]. Neurology, 2008, 70: 1518- 1524.
[9] Tang CW, Chang FC, Chern CM, et al. Stenting versus medical treatment for severe symptomatic intracranial stenosis[J]. AJNR Am J Neuroradiol, 2011, 32: 911- 916.
[10] Derdeyn CP, Chimowitz MI, Lynn MJ, et al. Aggressive medical treatment with or without stenting in high- risk patients with intracranial artery stenosis(SAMMPRIS): the final results of a randomised trial[J]. Lancet, 2014, 383: 333- 341.
[11] Compter A, van der Worp HB, Schonewille WJ, et al. Stenting versus medical treatment in patients with symptomatic vertebral artery stenosis: a randomised open- label phase 2 trial[J]. Lancet Neurol, 2015, 14: 606- 614.
[12] Markus HS, Larsson SC, Kuker W, et al. Stenting for symptomatic vertebral artery stenosis[J]. Neurology, 2017, 89: 1229- 1236.
[13] Yue X, Xi G, Lu T, et al. Influence of residual stenosis on clinical outcome and restenosis after middle cerebral artery stenting[J]. Cardiovasc Intervent Radiol, 2011, 34: 744- 750.
[14] Hwang YH, Kim YW, Kang DH, et al. Impact of target arterial residual stenosis on outcome following endovascular revasculari-zation[J]. Stroke, 2016, 47: 1850- 1857.
[15] 李宝民,缪中荣,王拥军,等. 症状性颅内动脉粥样硬化性狭窄血管内治疗中国专家共识2018[J]. 中国卒中杂志, 2018, 13:594- 604.
[16] Zhu SG, Zhang RL, Liu WH, et al. Predictive factors for in- stent restenosis after balloon- mounted stent placement for symptomatic intracranial atherosclerosis[J]. Eur J Vasc Endovasc Surg, 2010, 40: 499- 506.
[17] Jiang WJ, Du B, Leung TW, et al. Symptomatic intracranial stenosis: cerebrovascular complications from elective stent placement[J]. Radiology, 2007, 243: 188- 197.
[18] Yu SC, Leung TW, Lee KT, et al. Learning curve of Wingspan stenting for intracranial atherosclerosis: single- center experience of 95 consecutive patients[J]. J Neurointerv Surg, 2014, 6: 212- 218.

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备注/Memo

备注/Memo:
(收稿日期:2019- 09- 05)
(本文编辑:边 佶)
更新日期/Last Update: 2020-08-16