CAJ | 학술논문

目的：评价颅内动脉狭窄支架成形术(ICASS)治疗症状性颅内动脉狭窄的疗效、安全性和中期效果。方法观察21例症状性颅内动脉狭窄患者 ICASS 术后的手术成功率、狭窄改善率及并发症发生率；比较分析术前、术后(1、3、6、12个月及2年) NIHSS 和 MRS 量表评分的变化及随访期间缺血性脑血管事件的发生情况。结果1例因术中脑出血,手术被迫中止,20例手术成功,手术技术成功率95.2%,血管平均狭窄率从治疗前(73.4±7.9)%降为治疗后(13.7±9.2)%,围手术期并发症发生率为4.8%。9例术后6个月接受 DSA 检查,血管平均狭窄率为(29.5±12.2)%,未发现再狭窄病例；术后3、6、12个月及2年 NIHSS 评分、MRS 评分均较术前显著改善(均 P <0.05)；随访期间发现2例短暂性脑缺血(TIA)、1例非治疗靶血管区缺血性脑卒中(CI)。单因素比较分析发现：高龄(≥75岁)、高血压、糖尿病、血脂异常、入组事件至血管内治疗时间>1个月、有2个以上独立危险因素、未系统进行基础疾病治疗的患者,术后易再发脑血管事件(均 P<0.05)。结论ICASS 治疗症状性颅内动脉狭窄相对安全有效,中期疗效满意,需注意围手术期可能发生严重并发症。
목적：평개로내동맥협착지가성형술(ICASS)치료증상성로내동맥협착적료효、안전성화중기효과。방법관찰21례증상성로내동맥협착환자 ICASS 술후적수술성공솔、협착개선솔급병발증발생솔；비교분석술전、술후(1、3、6、12개월급2년) NIHSS 화 MRS 량표평분적변화급수방기간결혈성뇌혈관사건적발생정황。결과1례인술중뇌출혈,수술피박중지,20례수술성공,수술기술성공솔95.2%,혈관평균협착솔종치료전(73.4±7.9)%강위치료후(13.7±9.2)%,위수술기병발증발생솔위4.8%。9례술후6개월접수 DSA 검사,혈관평균협착솔위(29.5±12.2)%,미발현재협착병례；술후3、6、12개월급2년 NIHSS 평분、MRS 평분균교술전현저개선(균 P <0.05)；수방기간발현2례단잠성뇌결혈(TIA)、1례비치료파혈관구결혈성뇌졸중(CI)。단인소비교분석발현：고령(≥75세)、고혈압、당뇨병、혈지이상、입조사건지혈관내치료시간>1개월、유2개이상독립위험인소、미계통진행기출질병치료적환자,술후역재발뇌혈관사건(균 P<0.05)。결론ICASS 치료증상성로내동맥협착상대안전유효,중기료효만의,수주의위수술기가능발생엄중병발증。
Objective To evaluate the curative effect,safety,and medium-term effect of intracranial artery stenosis stent (ICASS) for the treatment of the symptomatic intracranial artery stenosis.Methods ICASS was performed in 21 cases with the symptomatic intracranial artery stenosis.The stenting success rate,the improvement rate of stenosis post-stenting and the incidence of complications were observed.The change of the scores of the Modified Rankin Scale (MRS)and National Institutes of Health Stroke Scale (NIHSS)between pre-and post-stenting (1 month,3 months,6 months,12 months and 2 years)and the occurrence of ischemic cerebrovascular events after stenting were compared and analyzed respectively.Results Except one case failed because of intracranial hemorrhage during the operation,other 20 patients were treated with endovascular stent plasty successfully,the total technical achievement ratio was 95.2%.The aver-age stenosis ratio decreased from (73.4±7.9)% to (13.7±9.2)%.The complications incidence was 4.8% within the peroperative. 9 patients were reviewed with DSA in 6 months,the average ratio of stenosis was (29.5 ±12.2)%,no patient was found with the restenosis.Compared with pre-stenting,the score of MRS and NIHSS at the follow-up duration of 3 months,6 months,12 months and 2 years post-stenting of patients were significant improved (all P < 0.05 ).During the follow-up period,2 patients were found with new transient ischemia attack (TIA),1 patient had non-targeted vascular CI without other target vascular therapy-related com-plications.Univariate analysis indicated that patients with elderly (≥ 75 years old),or hypertension,or diabetes,or dyslipidemia,or in the set of events to endovascular treatment for longer than 1 month,or with more than two independent risk factors for patients with underlying diseases treatment,or without systemic therapy,whom would be much more easily to reoccur the cerebrovascular events in post-operation(all P <0.05 ).Conclusion ICASS should be an effective and safe therapeutic method to the symptomatic intracra-nial arterial stenosis.The medium-term efficacy is significant.Serious complications might still be emerge with endovascular stent plasty,so close attention must be paid with.