CAJ | 학술논문

目的：探讨血管内治疗与单纯药物治疗症状性颅内动脉狭窄的疗效。方法回顾性分析颅内动脉狭窄145例患者的临床资料,根据患者或家属意愿分为血管内治疗组72例和药物治疗组73例,分别行血管内治疗手术(使用Gateway球囊、Wingspan支架、Apollo支架)或药物治疗(阿司匹林100 mg /d、氯吡格雷75 mg/d、阿托伐他汀20~40 mg/d),随访观察1、3、6、9、12个月的卒中及短暂性脑缺血发作(TIA)发生率、再狭窄率(以狭窄率>50%为标准),并进行两组间比较。结果(1)血管内治疗组在药物治疗基础上成功置入支架70枚,支架置入成功率为98．6%(70/71)；血管内治疗组共发生并发症7例(9．9%),其中合并出血2例,饮水呛咳、声音嘶哑、眩晕、头痛、兴奋各1例；1例脑出血病情恶化死亡,其他患者经积极内科治疗均痊愈出院,未遗留严重后遗症。(2)血管内治疗组治疗后12个月卒中复发率为8．4%(6例,均为TIA),药物治疗组为26．0%[19例,其中16例(占84．2%)为小卒中],差异有统计学意义(χ2=7．752,P<0．01)；治疗后12个月两组再狭窄发生率或狭窄加重发生率分别为5．6%(4例)和6．8%(5例),差异无统计学意义(χ2=0．091,P>0．05)。结论血管内治疗症状性颅内动脉狭窄与药物治疗比较,疗效更显著,改善患者临床预后优于药物治疗。
목적：탐토혈관내치료여단순약물치료증상성로내동맥협착적료효。방법회고성분석로내동맥협착145례환자적림상자료,근거환자혹가속의원분위혈관내치료조72례화약물치료조73례,분별행혈관내치료수술(사용Gateway구낭、Wingspan지가、Apollo지가)혹약물치료(아사필림100 mg /d、록필격뢰75 mg/d、아탁벌타정20~40 mg/d),수방관찰1、3、6、9、12개월적졸중급단잠성뇌결혈발작(TIA)발생솔、재협착솔(이협착솔>50%위표준),병진행량조간비교。결과(1)혈관내치료조재약물치료기출상성공치입지가70매,지가치입성공솔위98．6%(70/71)；혈관내치료조공발생병발증7례(9．9%),기중합병출혈2례,음수창해、성음시아、현훈、두통、흥강각1례；1례뇌출혈병정악화사망,기타환자경적겁내과치료균전유출원,미유류엄중후유증。(2)혈관내치료조치료후12개월졸중복발솔위8．4%(6례,균위TIA),약물치료조위26．0%[19례,기중16례(점84．2%)위소졸중],차이유통계학의의(χ2=7．752,P<0．01)；치료후12개월량조재협착발생솔혹협착가중발생솔분별위5．6%(4례)화6．8%(5례),차이무통계학의의(χ2=0．091,P>0．05)。결론혈관내치료증상성로내동맥협착여약물치료비교,료효경현저,개선환자림상예후우우약물치료。
Objective To investigate the efficacy comparison of endovascular therapy and simple medical therapy for symptomatic intracranial artery stenosis. Methods A total of 145 patients with intracranial artery stenosis were analyzed retrospectively. They were divided into either an endovascular therapy group (n=72) or a medical therapy group (n=73). They were treated with endovascular therapy (gateway balloon,wingspan stents,Apollo stents) or medical therapy (aspirin 100 mg/d,clopidogrel 75mg/d, and atorvastatin 20-40 mg/d) according the willingness of the patients or their family members. The incidences of stroke and transient ischemic attack ( TIA ) , and restenosis rate ( stenosis rate >50% as a standard) during 1-,3-,6-,9-,and 12-month follow-up periods were observed and compared. Results On the basis of medical therapy,the patients of the endovascular therapy group were successfully stented. The success rate of stenting was 98. 6% (70/71). Seven patients had complications in the endovascular therapy group (9.9%),2 of them complicated with hemorrhage(one of was died),drinking cough,hoarseness, dizziness,headache,and excitement were one case in each, the other patients were cured and discharged with active medical treatment, and they did not have serious sequelae. At 12 months after treatment, the stroke recurrence rate of the endovascular therapy group was 8. 4% (n=6,both were TIA),and that of the medical therapy group was 26. 0% (84. 2% was minor stroke). There was significant difference (χ2 =7. 752,P<0. 01);at 12 months after treatment,the incidences of restenosis and aggravated stenosis were 5. 6% (n=4) and 6. 8% (n=5) respectively. There was no significant difference (χ2 =0. 091,P>0. 05). Conclusion Compared with the medical therapy,the efficacy of endovascular therapy for symptomatic intra-cranial arterial stenosis is more significant. The improvement of clinical prognosis is superior to medical therapy.