中华实验外科杂志
中華實驗外科雜誌
중화실험외과잡지
CHINESE JOURNAL OF EXPERIMENTAL SURGERY
2015年
2期
254-257
,共4页
动脉粥样硬化%支架%狭窄%颅内动脉疾病
動脈粥樣硬化%支架%狹窄%顱內動脈疾病
동맥죽양경화%지가%협착%로내동맥질병
Atherosclerosis%Stent%Stenosis%Intracranial arteries disease
目的 评价Wingspan支架治疗症状性颅内动脉粥样硬化狭窄的安全性,探讨并发症的相关因素.方法 收集2007年7月至2013年4月在我中心接受Wingspan支架成形术治疗的433例颅内动脉粥样硬化狭窄患者,所有患者病变狭窄程度≥70％且伴有狭窄病变相关的卒中或短暂性脑缺血发作.将本中心术者早期完成的100例病例做为经验积累阶段组,而近期完成的333例做为技术成熟阶段组.采用x2检验或Fisher精确检验对可能影响围手术期并发症的因素进行分析.结果 433例患者中429例成功实施支架成形术(99.1％),狭窄度由术前的(82.3±7.6)％改善为术后的(16.6±6.6)％;围手术期30 d内29例(6.7％)患者出现卒中或死亡,其中致死致残性卒中7例(1.6％);30 d内发生缺血性卒中21例(4.8％),出血性卒中8例(1.8％);基底动脉30 d内总的卒中率、缺血性卒中率、穿支卒中率明显高于其他部位(P＜0.01),而大脑中动脉30 d内出血性卒中发生率明显高于其他部位(3.6％比0.4％,P＜0.05);经验积累阶段组总的围手术期卒中率明显高于技术成熟阶段组(13.0％比4.8％,P＜0.01),但围手术期穿支卒中发生率在经验积累阶段与技术成熟阶段比较差异无统计学意义(3.0％比3.0％,P＞0.01).结论 颅内Wingspan支架成形术安全可行;基底动脉缺血并发症高于其他部位而大脑中动脉出血并发症高于其他部位;操作相关的并发症受术者经验的影响,但穿支并发症并不随术者手术经验的积累而减少.
目的 評價Wingspan支架治療癥狀性顱內動脈粥樣硬化狹窄的安全性,探討併髮癥的相關因素.方法 收集2007年7月至2013年4月在我中心接受Wingspan支架成形術治療的433例顱內動脈粥樣硬化狹窄患者,所有患者病變狹窄程度≥70％且伴有狹窄病變相關的卒中或短暫性腦缺血髮作.將本中心術者早期完成的100例病例做為經驗積纍階段組,而近期完成的333例做為技術成熟階段組.採用x2檢驗或Fisher精確檢驗對可能影響圍手術期併髮癥的因素進行分析.結果 433例患者中429例成功實施支架成形術(99.1％),狹窄度由術前的(82.3±7.6)％改善為術後的(16.6±6.6)％;圍手術期30 d內29例(6.7％)患者齣現卒中或死亡,其中緻死緻殘性卒中7例(1.6％);30 d內髮生缺血性卒中21例(4.8％),齣血性卒中8例(1.8％);基底動脈30 d內總的卒中率、缺血性卒中率、穿支卒中率明顯高于其他部位(P＜0.01),而大腦中動脈30 d內齣血性卒中髮生率明顯高于其他部位(3.6％比0.4％,P＜0.05);經驗積纍階段組總的圍手術期卒中率明顯高于技術成熟階段組(13.0％比4.8％,P＜0.01),但圍手術期穿支卒中髮生率在經驗積纍階段與技術成熟階段比較差異無統計學意義(3.0％比3.0％,P＞0.01).結論 顱內Wingspan支架成形術安全可行;基底動脈缺血併髮癥高于其他部位而大腦中動脈齣血併髮癥高于其他部位;操作相關的併髮癥受術者經驗的影響,但穿支併髮癥併不隨術者手術經驗的積纍而減少.
목적 평개Wingspan지가치료증상성로내동맥죽양경화협착적안전성,탐토병발증적상관인소.방법 수집2007년7월지2013년4월재아중심접수Wingspan지가성형술치료적433례로내동맥죽양경화협착환자,소유환자병변협착정도≥70％차반유협착병변상관적졸중혹단잠성뇌결혈발작.장본중심술자조기완성적100례병례주위경험적루계단조,이근기완성적333례주위기술성숙계단조.채용x2검험혹Fisher정학검험대가능영향위수술기병발증적인소진행분석.결과 433례환자중429례성공실시지가성형술(99.1％),협착도유술전적(82.3±7.6)％개선위술후적(16.6±6.6)％;위수술기30 d내29례(6.7％)환자출현졸중혹사망,기중치사치잔성졸중7례(1.6％);30 d내발생결혈성졸중21례(4.8％),출혈성졸중8례(1.8％);기저동맥30 d내총적졸중솔、결혈성졸중솔、천지졸중솔명현고우기타부위(P＜0.01),이대뇌중동맥30 d내출혈성졸중발생솔명현고우기타부위(3.6％비0.4％,P＜0.05);경험적루계단조총적위수술기졸중솔명현고우기술성숙계단조(13.0％비4.8％,P＜0.01),단위수술기천지졸중발생솔재경험적루계단여기술성숙계단비교차이무통계학의의(3.0％비3.0％,P＞0.01).결론 로내Wingspan지가성형술안전가행;기저동맥결혈병발증고우기타부위이대뇌중동맥출혈병발증고우기타부위;조작상관적병발증수술자경험적영향,단천지병발증병불수술자수술경험적적루이감소.
Objective To assess the safety of stenting for symptomatic intracranial atherosclerosis with Wingspan stents and debate the factors related to complications.Methods 433 consecutive patients with intracranial atherosclerosis were treated with Wingspan stents from July 2007 to April 2013 in our center,all of the patients included suffered from ischemic stroke or transient ischemic attack attributed to the atherosclerosis stenosis with narrowing of at least 70％.the initial 100 cases completed by the operators were taken into the unskilled stage and the rest 333 cases were taken into the skilled stage.A Chi-squared or Fisher' s exact test was used to analyse the factors possible related to the complications.Results Stenting procedures were successfully performed in 429 of 433 cases (99.1％),The mean stenosis was reduced from (82.3 ± 7.6) ％ to (16.6 ± 6.6) ％ ; strokes or death happened in 29 cases within 30 days,among these,7 patients suffered from disabling or fatal strokes; 21 (4.8％)cases had ischemic strokes within 30 days and 8 (1.8％)cases had hemorrhagic strokes within 30 days; the rates of strokes,ischemic strokes、perforator strokes in basilar artery stentings within 30 days were apparently higher than those in other artery stentings; the rate of hemorrhagic strokes within 30 days in middle cerebral artery stentings was higher than in other arteries stentings; The rate of strokes within 30 days at the unskilled stage was apparently higher than at the skilled stage (13.0％ vs.4.8％,P ＜0.01) ; but the rates of perforator strokes within 30 days had almost no difference between the unskilled stage and skilled stage (3.0％ vs.3.0％,P ＞ 0.05).Conclusion Stenting with Wingspan for intracranial atherosclerosis stenosis was feasible and safe and associated with a low periprocedural complication rate; the ischemic strokes rate within 30 days in basilar artery stentings was higher than in other arteries stentings; the rate of hemorrhagic strokes within 30 days in middle cerebral artery was higher than in other arteries stentings; the complications related to the operation were influenced by the operators' experience frequently ; but the rate of perforator strokes could not be reduced by the technically skilled operators.
