CAJ | 학술논문

目的评价Wingspan支架系统治疗症状性大脑中动脉重度粥样硬化狭窄的安全性和预防缺血性卒中复发的长期效果.方法回顾性分析我中心2007年7月至2011年6月完成的大脑中动脉狭窄Wingspan支架成形术69例患者的临床资料,记录并统计入组患者的基线资料、手术前后及随访时的影像表现、围手术期不良事件发生情况、再狭窄率、远期临床随访过程中缺血性事件发生情况,30 d内所有卒中及30 d后同侧性卒中的累积发生率采用Kaplan-Meier生存分析法表示.结果入组的69例患者中67例成功置入支架,技术成功率97.1％(67/69).血管狭窄率由术前(80.1±8.0)％降至术后(15.2±6.4)％.所有患者均获得围手术期30 d内的临床资料,围手术期7例(10.1％)出现并发症,包括4例(5.8％,4/69)出血性卒中、3例(4.3％,3/69)缺血性卒中,其中死亡2例(2.9％,2/69)、重度残疾1例(1.4％,1/69).54例患者手术30 d后进行临床随访,随访时间为24～ 69个月,平均(39±13)个月.随访期间4例(7.4％,4/54)出现同侧缺血性事件,包括3(5.6％,3/54)例同侧卒中、1例(1.9％,1/54)同侧TIA;2年累积卒中率13.7％(95％CI 5.3％～ 22.1％),3年累积卒中率15.9％(95％CI 6.7％～ 25.1％).36例患者进行影像随访,影像随访中位时间7个月(6 ～ 69个月),6例(16.7％)出现再狭窄,其中2例为症状性再狭窄.结论 Wingspan支架成形术对大脑中动脉狭窄远期缺血性卒中的预防效果显著,但在开展此项技术的早期相对较高的围手术期并发症发生率影响了支架成形术的总体疗效.
목적 평개Wingspan지가계통치료증상성대뇌중동맥중도죽양경화협착적안전성화예방결혈성졸중복발적장기효과.방법 회고성분석아중심2007년7월지2011년6월완성적대뇌중동맥협착Wingspan지가성형술69례환자적림상자료,기록병통계입조환자적기선자료、수술전후급수방시적영상표현、위수술기불량사건발생정황、재협착솔、원기림상수방과정중결혈성사건발생정황,30 d내소유졸중급30 d후동측성졸중적루적발생솔채용Kaplan-Meier생존분석법표시.결과 입조적69례환자중67례성공치입지가,기술성공솔97.1％(67/69).혈관협착솔유술전(80.1±8.0)％강지술후(15.2±6.4)％.소유환자균획득위수술기30 d내적림상자료,위수술기7례(10.1％)출현병발증,포괄4례(5.8％,4/69)출혈성졸중、3례(4.3％,3/69)결혈성졸중,기중사망2례(2.9％,2/69)、중도잔질1례(1.4％,1/69).54례환자수술30 d후진행림상수방,수방시간위24～ 69개월,평균(39±13)개월.수방기간4례(7.4％,4/54)출현동측결혈성사건,포괄3(5.6％,3/54)례동측졸중、1례(1.9％,1/54)동측TIA;2년루적졸중솔13.7％(95％CI 5.3％～ 22.1％),3년루적졸중솔15.9％(95％CI 6.7％～ 25.1％).36례환자진행영상수방,영상수방중위시간7개월(6 ～ 69개월),6례(16.7％)출현재협착,기중2례위증상성재협착.결론 Wingspan지가성형술대대뇌중동맥협착원기결혈성졸중적예방효과현저,단재개전차항기술적조기상대교고적위수술기병발증발생솔영향료지가성형술적총체료효.
Objective To assess the safety and long-term efficacy of the treatment for symptomatic atherosclerotic high-grade stenosis in middle cerebral artery with Gateway-Wingspan system.Methods A total of 69 cases treated with Wingspan stenting for symptomatic middle cerebral artery high-grade stenosis from July 2007 to June 201 1 in our hospital were reviewed.The baseline state of the patients,angiographic findings of pre-or post-procedure or during follow-up,peri-procedural complications,In-stent restenosis,ischemic events during the long-term follow-up were recorded.The cumulative probability of any stroke in the 30 days and ipsilateral strokes beyond 30 days was estimated using the Kaplan-Meier method.Results Sixty-seven of 69 patients were successfully stented(successful rate,97.1％).The mean degree of stenosis reduced from(80.1±8.0) ％ to(15.2±6.4) ％.All the information of 69 patients within 30 days was collected.Seven complications were recorded and the rate was 10.1％ (7/69).The complications included four hemorrhagic strokes and three ischemic strokes.Two of them were dead and one of them was disabled.Clinical follow-up beyond 30 days was achieved in 54 patients with follow up time of more than two years.The mean follow-up period was 39 months in 54 patients.In the period,four ischemic events(7.4％,4/54) happened,with 3(5.6％,3/54) ipsilateral recurrent strokes and 1(1.9％,1/54) ipsilateral transient ischemic attack.The cumulative probability of adverse events was 13.7％(95％CI 5.3％-22.1％) at 2 years and 15.9％ (95％CI 6.7％-25.1％) at 3 years.The median imaging follow-up was seven months(Range,6-69 months) in 36 patients.Six patients(16.7％) suffered from in-stent restenosis and 2 had symptomatic restenosis.Conclusions Stenting for symptomatic atherosclerotic high-grade stenosis in the middle cerebral artery with wingspan has prominent long-term preventative effect against ischemic strokes.But the relatively high rate of peri-procedural complications at the early stage may influence the curative effect.