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单纯小球囊血管成形术治疗症状性颅内动脉粥样硬化性狭窄复杂病变的近期疗效分析

Sole angioplasty with tiny balloon for high-risk complex symptomatic intracranial atherosclerotic stenosis

摘要:

目的 探讨单纯小球囊血管成形术治疗症状性颅内动脉粥样硬化性狭窄(ICAS)的安全性与近期疗效.方法 回顾性分析2016年9月至2017年11月北京医院神经外科应用单纯小球囊(直径≤2 mm)成形术治疗的11例症状性ICAS复杂病变高危患者的临床、影像、手术及随访资料.男性6例,女性5例,平均年龄63.6岁(范围:45~ 77岁).临床表现为短暂性脑缺血发作4例,进展性卒中3例,反复卒中3例,1例为拟行结肠癌根治术者.狭窄部位为颈内动脉-大脑中动脉1例,大脑中动脉M1段4例、M1~2段1例,大脑前动脉A1段2例,椎动脉V4段3例;术前平均狭窄程度为92%.Mori分型为A型3例,B型4例,C型4例.前向血流改良脑梗死溶栓(mTICI)分级1~2a级8例,2b级3例.侧支代偿分级2级5例,3级6例.结果 10例患者手术成功完成.围手术期发生并发症1例,术后即刻前向血流mTICI分级2b~3级10例.出院预后良好(改良Rankin评分0~2级)10例.平均随访7.4个月,1例仍有短暂性脑缺血发作;术后3个月8例接受影像学复查,病变稳定.结论 对于药物治疗无效的症状性ICAS复杂病变,单纯小球囊血管成形术治疗相对安全,近期疗效满意.

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abstracts:

Objective To explore the safety and short-term efficacy of sole angioplasty with tiny balloon for symptomatic intracranial atherosclerotic stenosis (ICAS) patients with complex lesions refractory.Methods Consecutive 11 patients with complex ICAS lesions treated by sole angioplasty with tiny balloon (diameter≤2 mm) from September 2016 to November 2017 at Department of Neurosurgery,Beijing Hospital were retrospectively reviewed.Patients' demographics,lesions characteristics,procedures,complications,and clinical and imaging follow-up data were collected.There were 6 male and 5 female patients with mean age of 63.6 years (range:45 to 77 years).Clinical manifestations were transient ischemia attack (TIA) in 4 cases,progressive ischemic stroke in 3 cases,recurrent stroke in 3 cases,and 1 case for preparation of scheduled radical resection of colon cancer.ICAS locations were middle cerebral artery M1 segment in 5 cases,M2 segment in 1 case,anterior cerebral artery A1 segment in 2 cases,and intracranial vertebral artery in 3 cases.Mean degree of ICAS stenosis was 92%.Lesion morphology was type A in 3 cases,B in 4 cases and C in 4 cases by Mori classification.Forward flow by modified thrombolysis in cerebral infarction (mTICI) was grade 1 to 2a in 8 cases,2b in 3 cases.Collateral compensation grading was grade 2 in 5 cases,grade 3 in 6 cases.Results Technique success rate was 10/11,peri-procedural complication rate was 1/11.Post-procedural forward flow in all cases had been enhanced and 10 cases obtained mTICI 2b to 3.Ten patients got favorable outcomes (modified Rankin score 0 to 2) at discharge.With a mean clinical follow-up time of 5.4 months,1 patient was found to have TIA recurrence.With a mean clinical follow-up time of 7.4 months,1 patient was found to have TIA recurrence.Eight in 11 cases obtained imaging followup during 3 months,and none restenosis was found.Conclusion For symptomatic ICAS complex lesions,sole angioplasty with tiny balloon demonstrates relatively high safety with satisfactory short-term clinical and imaging results.

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