CAJ | 학술논문

目的探讨血管内介入及单纯药物治疗对重度颅内前循环动脉粥样硬化狭窄的长期疗效.方法回顾性分析南京卒中注册系统因重度前循环颅内动脉粥样硬化导致短暂性脑缺血发作或脑梗死的患者,按有无行血管内介入治疗分为血管内介入组和单纯药物组.主要终点事件为30 d内任何脑血管事件、死亡及30 d后责任血管同侧缺血性脑血管事件；次要终点事件为30 d后责任血管同侧缺血性脑血管事件.比较两组终点事件累积发生率及研究次要终点事件的独立危险因素.结果共纳入142例,血管介入组69例,单纯药物组73例.两组主要终点事件累积发生率差异无统计学意义,其30 d、1年、2年、3年的累积主要终点事件发生率分别为13％、15％、21％、29％；1％、15％、22％、27％.但血管内介入组次要终点事件累积发生率明显低于单纯药物组(P =0.026),2组1、2、3年累积事件发生率分别为5％、13％、15％；14％、21％、34％.Cox逐步回归分析显示治疗方式(HR=2.601,95％ CI1.042 ～6.495,P=0.041)和主要血管危险因素的数量(HR =3.322,95％ CI 1.116～9.894,P=0.031)是次要终点事件的独立危险因素.结论与单纯药物治疗比较,血管内介入治疗可以明显减少重度颅内动脉狭窄患者手术30 d后的缺血性卒中复发,但两组的长期疗效差异无统计学意义,其原因在于介入治疗有较高的围手术期并发症,抵消了其预防复发的长期疗效.
목적 탐토혈관내개입급단순약물치료대중도로내전순배동맥죽양경화협착적장기료효.방법 회고성분석남경졸중주책계통인중도전순배로내동맥죽양경화도치단잠성뇌결혈발작혹뇌경사적환자,안유무행혈관내개입치료분위혈관내개입조화단순약물조.주요종점사건위30 d내임하뇌혈관사건、사망급30 d후책임혈관동측결혈성뇌혈관사건；차요종점사건위30 d후책임혈관동측결혈성뇌혈관사건.비교량조종점사건루적발생솔급연구차요종점사건적독립위험인소.결과 공납입142례,혈관개입조69례,단순약물조73례.량조주요종점사건루적발생솔차이무통계학의의,기30 d、1년、2년、3년적루적주요종점사건발생솔분별위13％、15％、21％、29％；1％、15％、22％、27％.단혈관내개입조차요종점사건루적발생솔명현저우단순약물조(P =0.026),2조1、2、3년루적사건발생솔분별위5％、13％、15％；14％、21％、34％.Cox축보회귀분석현시치료방식(HR=2.601,95％ CI1.042 ～6.495,P=0.041)화주요혈관위험인소적수량(HR =3.322,95％ CI 1.116～9.894,P=0.031)시차요종점사건적독립위험인소.결론 여단순약물치료비교,혈관내개입치료가이명현감소중도로내동맥협착환자수술30 d후적결혈성졸중복발,단량조적장기료효차이무통계학의의,기원인재우개입치료유교고적위수술기병발증,저소료기예방복발적장기료효.
Objective To compare long-term outcome by endovascular treatment and medical treatment in severe intracranial atherosclerotic stenosis of anterior circulation.Methods Consecutive patients in Nanjing Stroke Registry Program who had transient ischemic attack or stroke attributed to severe intracranial atherosclerotic stenosis of anterior circulation were retrospectively reviewed.Patients were either treated with endovascular therapy (endovascular treatment group) or with medicine (medical treatment group).The primary endpoint was any stroke or death within 30 days after enrollment and ischemic events in the territory of qualifying artery beyond 30 days after a revascularization procedure for the qualifying lesion.The secondary endpoint was stroke in territory of qualifying artery beyond 30 days.The cumulative event rates were compared between two groups and identifying the independence risk factors of secondary endpoint.Results Of the 142 patients enrolled,69 patients were in endovascular treatment group and 73 patients in medical treatment group.The cumulative event rates of a primary endpoint over time in 30-day,1-year,2-year,3-year in endovascular treatment group and in medical treatment group were 13％,15％,21％,29％ and 1％,15％,22％,27％,respectively.The occurrence was not statistically different between two groups.The occurrences of a secondary endpoint in endovascular treatment group and in medical group at 1-year,2-year,3-year were 5％,13％,15％ and 14％,21％,34％ respectively,and those in endovascular treatment group was significantly lower (P =0.026).Multivariate Cox analysis revealed that therapeutic modality (HR =2.601,95％ CI 1.042-6.495,P =0.041) and the number of major vascular risk factors (HR =3.322,95％ CI 1.116-9.894,P =0.031) are independence risk factors for stroke in territory of qualifying artery beyond 30 days.Conclusions The long-term results from endovascular treatment for anterior circulation severe intracranial atherosclerotic stenosis bad no statistical difference comparing with that of medical treatment.But the effect of endovascular treatment in preventing stroke in territory of qualifying artery was superior to medical treatment beyond 30 days.