CAJ | 학술논문

目的观察症状性颅内动脉狭窄支架成形术的术中和术后1个月内脑血管并发症,并分析其高危因素.方法回顾性分析2007年7月至2012年6月306例症状性颅内动脉狭窄,Wingspan支架成形术的术中及术后1个月内脑血管并发症情况,包括术中至出院时发生的短暂性脑缺血发作(TIA)、脑梗死、脑出血和死亡.患者中男178例、女128例,年龄26 ～ 80岁、平均(59±11)岁.病变位于大脑中动脉水平段(M1段)114处、颈内动脉颅内段(ICA)50处、椎动脉颅内段(V4)75处、椎动脉与基底动脉汇合处(VBA) 14处、基底动脉76处.术后根据脑血管造影复查情况并再次评价神经体征.结果为计数资料,采用x2检验,而当理论频数小于5时采用Fisher检验,分析患者基本资料和病变特点对并发症的影响,P ＜0.05为差异有统计学意义.结果 306例中303例成功行Wingspan支架成形术,手术成功率99％.脑血管并发症发生率6.9％ (21/303),其中非致残性并发症4.6％ (14/303)、致残性并发症1.6％(5/303),病死率0.7％ (2/303)；出血性并发症发生率为2.0％(6/303),3例为技术相关性、3例怀疑高灌注综合征；缺血性并发症发生率为5.0％ (15/303),其中穿支卒中8例、TIA发作3例、脑梗死2例、支架内血栓2例.6例出血性并发症患者中2例死亡,2例重度致残；15例缺血性并发症中4例中度致残,前者明显高于后者(x2 =2.908,P＜0.05)；6例出血性并发症中5例发生于大脑中动脉,高于其他部位(x2=1.168,P＜0.05)；15例缺血性并发症中8例为穿支卒中,为首要原因,其中6例发生于基底动脉,明显高于其他部位(x2=4.263,P＜0.05).结论症状性颅内动脉狭窄支架成形术的术中和术后1个月内脑血管并发症发生率为6.9％.大脑中动脉狭窄支架治疗容易发生出血并发症,基底动脉狭窄支架治疗容易发生穿支卒中.
목적 관찰증상성로내동맥협착지가성형술적술중화술후1개월내뇌혈관병발증,병분석기고위인소.방법 회고성분석2007년7월지2012년6월306례증상성로내동맥협착,Wingspan지가성형술적술중급술후1개월내뇌혈관병발증정황,포괄술중지출원시발생적단잠성뇌결혈발작(TIA)、뇌경사、뇌출혈화사망.환자중남178례、녀128례,년령26 ～ 80세、평균(59±11)세.병변위우대뇌중동맥수평단(M1단)114처、경내동맥로내단(ICA)50처、추동맥로내단(V4)75처、추동맥여기저동맥회합처(VBA) 14처、기저동맥76처.술후근거뇌혈관조영복사정황병재차평개신경체정.결과위계수자료,채용x2검험,이당이론빈수소우5시채용Fisher검험,분석환자기본자료화병변특점대병발증적영향,P ＜0.05위차이유통계학의의.결과 306례중303례성공행Wingspan지가성형술,수술성공솔99％.뇌혈관병발증발생솔6.9％ (21/303),기중비치잔성병발증4.6％ (14/303)、치잔성병발증1.6％(5/303),병사솔0.7％ (2/303)；출혈성병발증발생솔위2.0％(6/303),3례위기술상관성、3례부의고관주종합정；결혈성병발증발생솔위5.0％ (15/303),기중천지졸중8례、TIA발작3례、뇌경사2례、지가내혈전2례.6례출혈성병발증환자중2례사망,2례중도치잔；15례결혈성병발증중4례중도치잔,전자명현고우후자(x2 =2.908,P＜0.05)；6례출혈성병발증중5례발생우대뇌중동맥,고우기타부위(x2=1.168,P＜0.05)；15례결혈성병발증중8례위천지졸중,위수요원인,기중6례발생우기저동맥,명현고우기타부위(x2=4.263,P＜0.05).결론 증상성로내동맥협착지가성형술적술중화술후1개월내뇌혈관병발증발생솔위6.9％.대뇌중동맥협착지가치료용역발생출혈병발증,기저동맥협착지가치료용역발생천지졸중.
Objective To retrospectively evaluate the cerebrovascular complications from stenting for symptomatic intracranial stenosis and to detect the factors associated with complications.Methods Medical records of Wingspan stenting were reviewed for 306 cases with symptomatic intracranial stenosis from July 2007 to February 2012,including transient ischemic attack,ischemic stroke,death and intracranial hemorrhage as clinical in-hospital complications.The location of lesions included middle cerebral artery level M1 (114 lesions),intracranial portion of the internal carotid artery (50 lesions),vertebral artery 4(75 lesions),venebro-basilar artery (14 lesions),basilar artery (76 lesions).Complications were evaluated and analyzed to find out whether they were associated with patient-or stenosis-related risk factors using x2test.Results The technical success rate was 99％ (303/306).Cerebrovascular complications rate was 6.9％ (21/303),with 1.6％ (14/303) of disabling stroke events and 0.7％ (2/303) of deaths.Hemorrhagic events were consisted of procedure-related events (3 cases),hyperperfusion (3 cases),ischemic events of perforator stroke (8 cases),transient ischemic attack (3 cases),embolization (2 cases),thrombosis in stent (2 cases).Hemorrhagic events were associated with significantly higher morbidity and mortality rates(x2 =2.908,P ＜ 0.05) and occurred more frequently after treatment of middle cerebral artery stenosis than other lesions(x2 =1.168,P ＜ 0.05).Perforating branches were detected to be affected mainly in the basilar artery than other locations (x2 =4.263,P ＜ 0.05).Conclusion The complication rates in the study are preliminary consistent with the previously published data.Hemorrhagic events are prone to occur in the treatment of middle cerebral artery stenosis,while perforating branches are affected mainly in the basilar artery.