摘要
目的探讨自膨式支架治疗基底动脉症状性粥样硬化性狭窄患者围手术期的并发症。方法回顾性分析2007年11月—2013年1月,51例接受Gateway球囊扩张+自膨式支架(Wing-span支架37例、Enterprise支架8例、Solitaire支架5例、Neuroform支架1例)置入治疗患者的临床资料。评估患者的临床表现、影像学特点及围手术期并发症发生率。结果①技术成功率为100%。基底动脉病变部位的平均狭窄率[中位数(M),范围]从术前的74(50～95)%下降至术后的26(0～48)%。4例(7.8%)患者出现了不同程度的言语不清、一侧肢体肌力减退等缺血症状,MRI检查提示桥脑新发梗死,考虑为穿支动脉闭塞引发的缺血事件。积极治疗后2例术后1个月症状缓解,2例仍有不同程度的神经功能障碍。②51例患者中有49%的狭窄部位在基底动脉下段,33.3%在中段,17.6%在上段。基底动脉上段狭窄支架置入治疗后,缺血并发症率高于基底动脉中下段(22.2%比4.8%),但因例数少,差异无统计学意义(χ2=3.115,P>0.05)。结论自膨式支架治疗基底动脉狭窄安全可行,但穿支动脉缺血事件是较常见的并发症,而且以基底动脉上段最为多见。
Objective To investigate the perioperative complications in patients with symptomatic atherosclerotic basilar artery stenosis treated with the self-expanding stents. Methods The clinical data of 51 patients who accepted Gateway balloon angioplasty and self-expanding stent implantation （37 using Wingspan stents, 8 using Enterprise stents, 5 using solitaire stents, and 1 using Neuroform stents） from November 2007 to January 2013 were analyzed retrospectively. The clinical manifestations, imaging fea- tures and incidence of periproeedure complications of the patients were evaluated. Results ①The techni-cal success rate was 100%. The mean stenosis rate of the basilar artery lesions was decreased from 74 （50-95）% before procedure to 26（0-48）% after procedure. Four patients （7.8%） had different de-grees of slurred speech and decreased unilateral limb muscle strength. MRI examination suggested pontine infarction due to obliteration of perforating arteries. The symptoms of 2 patients alleviated at 1 month after active treatment, and the other 2 patients still remained varying degrees of neurological impairment. ②Of the 51 patients, 49% , 33% and 17.6% of their hasilar artery stenosis were in the lower, middle and up-per segments, respectively. After stenting, the ischemie complication rate in patients with upper segment basilar artery stenosis was higher than that with lower and middle segments （22.2% vs. 4.8% ） , but the difference was not statistically significant （X^2 = 3. 115, P 〉 0.05）. Conclusion The self-expandable stents in the treatment of basilar artery stenosis are safe and feasible, however, the isehemie events due to perforating arteries obliteration are common in this group, and most of the events are occurred in patients with upper segments basilar artery stenosis.
出处
《中国脑血管病杂志》
CAS
2013年第7期348-352,共5页
Chinese Journal of Cerebrovascular Diseases
基金
国家自然科学基金(30973102)
上海市市级医院新兴前沿技术联合攻关项目(SHDC12012103)
长海医院1255学科建设计划(CH125520102)
关键词
基底动脉狭窄
自膨胀式支架
并发症
Basilar artery stenosis
Self-expanding stent
Complication
