CAJ | 학술논문

目的评价闭塞超过24 h的非急性期颅内椎基底动脉闭塞行腔内再通的可行性、安全性及中期疗效.方法回顾性搜集行腔内支架成形或球囊扩张成形术开通的非急性期颅内椎基底动脉闭塞患者资料,根据闭塞是否累及基底动脉分为椎动脉闭塞组(15例)和基底动脉闭塞组(12例),记录围手术期并发症、随访时再发事件短暂性脑缺血发作及卒中发生情况,使用非参数秩和检验比较手术前后改良Rankin量表(mRS)评分变化情况.结果 27例患者26例闭塞动脉(96.3％)成功开通.术后评估,13例患者病情改善,11例稳定,3例恶化.27例患者的中位mRS评分由术前的4分[四分位数范围(IR),2～5分]恢复到出院时的3分(IR,1～5分),差异有统计学意义(Z=3.116,P =0.002).5例患者出现手术相关并发症,其中2例基底动脉夹层,1例术中支架内血栓形成,1例术中移位栓塞,1例术后急性闭塞.27例患者临床中位随访21个月,mRS为1分(IR,0～3分),mRS≤2分患者的比例由术前的25.9％(7/27)提高到63.0％(17/27).在此期间死亡3例,再发卒中1例,再发短暂性脑缺血发作2例.17例患者影像中位随访9个月(极值范围,5 ～ 30个月),再发狭窄6例,其中3例为症状性.亚组分析显示:与各自术前mRS评分相比,出院时15例椎动脉闭塞组(Z=2.111,P=0.035)和12例基底动脉闭塞组(Z=2.333,P=0.020)患者的mRS评分改善均有统计学意义.结论针对闭塞超过24 h的非急性期颅内椎基底动脉闭塞患者行腔内再通技术上是可行的,可以改善患者中期预后,但并发症及支架内再狭窄的发生率较高.
목적 평개폐새초과24 h적비급성기로내추기저동맥폐새행강내재통적가행성、안전성급중기료효.방법 회고성수집행강내지가성형혹구낭확장성형술개통적비급성기로내추기저동맥폐새환자자료,근거폐새시부루급기저동맥분위추동맥폐새조(15례)화기저동맥폐새조(12례),기록위수술기병발증、수방시재발사건단잠성뇌결혈발작급졸중발생정황,사용비삼수질화검험비교수술전후개량Rankin량표(mRS)평분변화정황.결과 27례환자26례폐새동맥(96.3％)성공개통.술후평고,13례환자병정개선,11례은정,3례악화.27례환자적중위mRS평분유술전적4분[사분위수범위(IR),2～5분]회복도출원시적3분(IR,1～5분),차이유통계학의의(Z=3.116,P =0.002).5례환자출현수술상관병발증,기중2례기저동맥협층,1례술중지가내혈전형성,1례술중이위전새,1례술후급성폐새.27례환자림상중위수방21개월,mRS위1분(IR,0～3분),mRS≤2분환자적비례유술전적25.9％(7/27)제고도63.0％(17/27).재차기간사망3례,재발졸중1례,재발단잠성뇌결혈발작2례.17례환자영상중위수방9개월(겁치범위,5 ～ 30개월),재발협착6례,기중3례위증상성.아조분석현시:여각자술전mRS평분상비,출원시15례추동맥폐새조(Z=2.111,P=0.035)화12례기저동맥폐새조(Z=2.333,P=0.020)환자적mRS평분개선균유통계학의의.결론 침대폐새초과24 h적비급성기로내추기저동맥폐새환자행강내재통기술상시가행적,가이개선환자중기예후,단병발증급지가내재협착적발생솔교고.
Objective To evaluate the technical feasibility,safety and mid-term effect of endovascular revascularization of nonacute intracranial vertebrobasilar artery occlusion.Methods Consecutive data of patients who suffered from nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours and underwent endovascular revascularization,were retrospectively collected and analyzed.Complications and recurrent events during the follow-up period were recorded.The modified Rankin scale (mRS) scores were used to compare the symptoms before and after the procedure.Results All 27 patients but 1 (96.3％) obtained successful recanalization.After the procedure,13 patients showed improvements,11 were stable,and 3 worse.The decline of median mRS scores,which was 4 [interquarter range(IR),2-5) preoperatively and 3 (IR,1-5) on discharge,showed significant statistical difference (Z =3.116,P =0.002).Five patients had procedural complications,namely 2 dissection,1 in-stent thrombosis during the operation,1 thrombus disruption and translocation during the operation and 1 acute reocclusion after operation.During the follow-up period with the median of 21 months,3 death,1 stroke and 2 transient ischemic attack occurred.The latest median mRS scores were 1 (IR,0-3).The ratio of patients with mRS ≤ 2 increased from 25.9％ (7/27) before operation to 63.0％ (17/27) at the follow up.Seventeen patients received imaging follow-up during the 9 months,with restenosis in 6 and symptom in 3 of them.Subgroup analyses revealed better functional recovery (lower mRS) both in patients with vertebral artery occlusion (Z =2.111,P =0.035) and those with basilar artery occlusion (Z =2.333,P =0.020).Conclusions Endovascular revascularization for the nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours is technically feasible,and improves disability recovery.However,the rates of procedural complication and restenosis are high.