CAJ | 학술논문

目的比较球囊扩张血管成形术、球囊扩张支架置入术和自膨式支架置入术治疗颅内动脉狭窄性病变的临床效果和影像学结果.方法选择南京卒中注册系统中因颅内动脉狭窄而行球囊扩张血管成形术或支架置入术的患者,根据手术方式的不同分为球囊扩张支架置入组、自膨式支架置入组和球囊扩张血管成形术组,比较其手术成功率、围手术期并发症发生率以及显著残余狭窄发生率.收集术后1、3、6、12和24个月时定期门诊或住院随访的临床和血管造影资料,比较2年内缺血性卒中和(或)死亡发生率以及再狭窄发生率.采用多因素Cox风险比例分析缺血性卒中复发和(或)死亡以及再狭窄的危险因素.结果 183例患者共192处狭窄性病变行球囊扩张血管成形术或支架置入术治疗,其中球囊扩张支架置入组92例,自膨式支架置入组42例,球囊扩张血管成形组49例,术前狭窄程度分别为(80.2±l2.8)％、(76.3±11.9)％和(89.7±10.2)％ (F=15.863,P=0.000),其他基线资料均无显著性差异.球囊扩张支架置入组、自膨式支架置入组和球囊扩张血管成形术成功率分别为96,7％、95.2％和91.8％(x2=1.646,P =0.439),围手术期并发症发生率分别为6.5％、14.3％和10.2％(Fisher精确概率法P=0.334),缺血性卒中和(或)死亡发生率分别为9.2％、4.8％和13.0％(Fisher精确概率法P=0.458),均无显著性差异.影像学随访显示,球囊扩张血管成形组再狭窄发生率为48.5％,虽然高于球囊扩张支架置入组的27.7％和自膨式支架置入组的34.8％,但无显著性差异(x2=4.176,P=0.124).多因素Cox比例风险分析显示,球囊扩张血管成形是术后再狭窄的独立危险因素(风险比2.490,95％可信区间1.247 ～4.969,P=0.010).结论与球囊扩张式支架置入相比,球囊扩张血管成形更易发生再狭窄,但其与术后缺血性卒中复发和(或)死亡风险无关.
목적 비교구낭확장혈관성형술、구낭확장지가치입술화자팽식지가치입술치료로내동맥협착성병변적림상효과화영상학결과.방법 선택남경졸중주책계통중인로내동맥협착이행구낭확장혈관성형술혹지가치입술적환자,근거수술방식적불동분위구낭확장지가치입조、자팽식지가치입조화구낭확장혈관성형술조,비교기수술성공솔、위수술기병발증발생솔이급현저잔여협착발생솔.수집술후1、3、6、12화24개월시정기문진혹주원수방적림상화혈관조영자료,비교2년내결혈성졸중화(혹)사망발생솔이급재협착발생솔.채용다인소Cox풍험비례분석결혈성졸중복발화(혹)사망이급재협착적위험인소.결과 183례환자공192처협착성병변행구낭확장혈관성형술혹지가치입술치료,기중구낭확장지가치입조92례,자팽식지가치입조42례,구낭확장혈관성형조49례,술전협착정도분별위(80.2±l2.8)％、(76.3±11.9)％화(89.7±10.2)％ (F=15.863,P=0.000),기타기선자료균무현저성차이.구낭확장지가치입조、자팽식지가치입조화구낭확장혈관성형술성공솔분별위96,7％、95.2％화91.8％(x2=1.646,P =0.439),위수술기병발증발생솔분별위6.5％、14.3％화10.2％(Fisher정학개솔법P=0.334),결혈성졸중화(혹)사망발생솔분별위9.2％、4.8％화13.0％(Fisher정학개솔법P=0.458),균무현저성차이.영상학수방현시,구낭확장혈관성형조재협착발생솔위48.5％,수연고우구낭확장지가치입조적27.7％화자팽식지가치입조적34.8％,단무현저성차이(x2=4.176,P=0.124).다인소Cox비례풍험분석현시,구낭확장혈관성형시술후재협착적독립위험인소(풍험비2.490,95％가신구간1.247 ～4.969,P=0.010).결론 여구낭확장식지가치입상비,구낭확장혈관성형경역발생재협착,단기여술후결혈성졸중복발화(혹)사망풍험무관.
Objective To compare the clinical efficacy and angiographic outcomes of balloon dilation angioplasty,balloon-expandable stent implantation and self-expanding stent implantation in the treatment of intracranial arterial stenosis.Methods The patients with intracranial arterial stenosis who met the indications of surgical intervention treated with balloon dilatation angioplasty and stent placement were selected from Nanjing Stroke Registry Program.According to the different interventional procedures,the patients were divided into the balloon expandable stenting goup,the self-expanding stents group and the balloon dilatation angioplasty group.The success rate of surgery,the perioperative complication rate and the significant residual stenosis rate were compared among the three groups.The clinical and angiographic assessments were performed through 1-,3-,6-,12- and 24-month regular outpatient or inpatient follow-up after procedure.The incidences of ischemic stroke and/or death and restenosis within 2 years were compared.Multivariate Cox proportional hazards analysis was used to analyze the risk factors for recurrent ischemic stroke and/or death and restenosis.Results A total of 183 patients with 192 stenoses performed balloon dilatation angioplasty or stenting,in which 92 were in the balloon expandable stenting goup,42 were in the self-expanding stents goup and 49 in the balloon dilatation angioplasty group.Their preoperative stenosis rates were 80.2 ±12.8％、76.3 ± 11.9％ and 89.7 ± 10.2％,respectively (F =15.863,P =0.000).There were no significant differences in other baseline data.The success rates of surgery in the balloon expandable stenting group,self-expanding stents group and balloon dilatation angioplasty group were 96.7％,95.2％ and 91.8％,respectively (x2 =1.646,P =0.439).The perioperative complication rates were 6.5％,14.3％ and 10.2％,respectively (Fisher exact test,P=0.334).The imaging follow-up showed that the restenosis rate in the balloon dilatation angioplasty group was 48.5％.Although it was high than 27.7％ in the balloon expandable stenting group and 34.8％ in the self-expanding stents group,there were no significant differences (x2 =4.176,P =0.124).Multivariate Cox proportional hazards analysis showed that balloon dilatation angioplasty was an independent risk factor for restenosis after procedure (hazard ratio 2.490,95％ confidence interval 1.247- 4.969,P=0.010).Conclusions Compared to the balloon expandable stenting,the balloon dilatation angioplasty is more likely to have restenosis,but it is not associated with the risks of postoperative recurrent ischemic stroke and/or death.