Neuroform EZ支架在治疗复杂症状性颅内动脉重度狭窄中的应用

doi:10.19723/j.issn.1671-167X.2019.05.008

摘要/Abstract

摘要：

目的:评估Neuroform EZ支架治疗复杂症状性重度颅内动脉粥样硬化性狭窄(intracranial atherosclerotic stenosis,ICAS)的安全性和有效性。方法:回顾性分析2016年1月至2017年12月于北京大学第三医院介入血管外科选用经微导管释放的Neuroform EZ支架治疗的18例复杂症状性ICAS(手术路径严重迂曲、病变>10 mm或闭塞、病变接近分叉、狭窄附近合并动脉瘤等)的患者资料。主要终点事件定义为术后30 d内任何脑卒中事件(含缺血性和出血性)或任何原因引起的死亡,次要终点事件为支架治疗成功以及随访期间支架内再狭窄(狭窄率>50%)。结果:18例均获得技术成功,血管狭窄率从85%±7%降为18%±6%,主要终点事件发生率为5.6%(1/18),为左椎动脉串联病变患者术后出现基底节区梗塞。无出血性脑卒中及死亡并发症,1例合并狭窄附近动脉瘤患者予二期栓塞治疗。12例获得数字减影血管造影(digital subtraction angiography,DSA)随访,随访 8~26个月,平均随访时间(16±8)个月,有2例患者(2/12,16.7%)出现支架内再狭窄,其中1例为症状性再狭窄,予支架内球囊扩张治疗。结论:Neuroform EZ支架治疗经严格选择的复杂症状性重度ICAS是安全有效的,较传统支架有其优势。

关键词: 颅内动脉硬化, 卒中, 支架

Abstract:

Objective: To assess the safety and efficacy of Neuroform EZ stent used in treatment of symptomatic complex severe intracranial atherosclerotic stenosis (ICAS). Methods: Clinical data of 18 patients with symptomatic complex severe ICAS undergoing Neuroform EZ stent angioplasty from January 2016 to December 2017 were retrospectively analyzed. All the lesions of the patients in this group were considered as complex ICAS, i.e. with severe tortuous access, long (>10 mm) or occlusive or bifurcation lesions, with concurrent aneurysms near the stenotic lesion. The primary outcome was defined as any stroke (including ischemic or hemorrhagic) or deaths from any cause after stenting procedure within 30 days. The secondary outcome was defined as successful revascularization and occurrence of >50% in-stent restenosis during the follow-up period. Results: All the 18 patients achieved technical success (100%) and mean stenosis rate was reduced from 85%±7% to 18%±6%. Of the 18 patients inclu-ded, the 30-day stroke or death was 5.6% (1/18), which presented as basal ganglia region infarction in a patient with tandem lesions on the left vertebral artery. There was no hemorrhagic and death complications that occurred in the patients of this group. One concurrent aneurysm was embolized with micro coil (stent assisted) by stages after 1 month. In this group 12 patients were followed up with digital subtraction angiography (DSA) after hospital discharge. The follow-up period ranged from 8 months to 26 months [mean: (16±8) months].During the follow-up period 2 patients in the 12 patients (2/12, 16.7%) developed in-stent restenosis (ISR) confirmed by DSA, and one of them was symptomatic res-tenosis and restored unobstructed blood flow after balloon angioplasty. Conclusion: Neuroform EZ stent for the treatment of highly screened symptomatic complex severe ICAS is safe and effective. It has its advantages over traditional stent.

Key words: Intracranial arteriosclerosis, Stroke, Stents

中图分类号:

R743.3

贾子昌,卞焕菊,李选,栾景源,王昌明,刘启佳,韩金涛. Neuroform EZ支架在治疗复杂症状性颅内动脉重度狭窄中的应用[J]. 北京大学学报（医学版）, 2019, 51(5): 835-839.

Zi-chang JIA,Huan-ju BIAN,Xuan LI,Jing-yuan LUAN,Chang-ming WANG,Qi-jia LIU,Jin-tao HAN. Application of Neuroform EZ stent in the treatment of severe intracranial arterial stenosis with complex symptomatic[J]. Journal of Peking University(Health Sciences), 2019, 51(5): 835-839.

图/表 3

图1

图2

表1

手术材料及临床结果(n=18)"

Items	Data
Balloon diameter, n(%)
1.5 mm/2.0 mm	11 (61.1)
2.5 mm/3.0 mm	7 (38.9)
Stent diameter, n(%)
2.5 mm	3 (16.7)
3.0 mm	5 (27.7)
3.5 mm	3 (16.7)
4.0 mm	3(16.7)
4.5 mm	4 (22.2)
Stent length, n(%)
15 mm	4 (22.2)
20 mm	8 (44.5)
30 mm	6 (33.3)
Mean rate of stenosis, $x ?$ ±s
Pre-operation	85%±7%
Post-operation	18%±6%
Primary outcomes (within 30 d), n(%)
Ischemic stroke	1 (5.6)
Hemorrhagic stroke	0
Death from any cause	0
Secondary outcomes, n(%)
Successful revascularization	18 (100.0)
In-stent restenosis during follow-up period^*	2 (16.7)
TIA during follow-up period^*	1 (8.3)

表1

参考文献 18

[1]	Wang Y, Zhao X, Liu L , et al. Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese Intracranial Atherosclerosis (CICAS) Study[J]. Stroke, 2014,45(3):663-669.
[2]	Wong LK . Global burden of intracranial atherosclerosis[J]. Int J Stroke, 2006,1(3):158-159.
[3]	Chimowitz MI, Lynn MJ, Howlett-Smith H , et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis[J]. N Engl J Med, 2005,352(13):1305-1316.
[4]	Chimowitz MI, Lynn MJ, Derdeyn CP , et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis[J]. N Engl J Med, 2011,365(11):993-1003.
[5]	Zaidat OO, Fitzsimmons BF, Woodward BK , et al. Effect of a balloon-expandable intracranial stent vs. medical therapy on risk of stroke in patients with symptomatic intracranial stenosis: the VISSIT randomized clinical trial[J]. JAMA, 2015,313(12):1240-1248.
[6]	Miao Z, Zhang Y, Shuai J . Study Group of registry study of sten-ting for symptomatic intracranial artery stenosis in China: Thirty-day outcome of a multicenter registry study of stenting for sympto-matic intracranial artery stenosis in China[J]. Stroke, 2015,46(10):2822-2829.
[7]	Wang Y, Miao Z, Wang Y , et al. Protocol for a prospective, multicenter registry study of stenting for symptomatic intracranial artery stenosis in China[J]. BMJ Open, 2014,4(8):e005175.
[8]	Sacco RL, Kargman DE, Gu Q , et al. Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study[J]. Stroke, 1995,26(1):14-20.
[9]	Cheng XQ, Tian JM, Zuo CJ , et al. Hemodynamic alterations in unilateral chronic middle cerebral artery stenosis patients and the effect of percutaneous transluminal angioplasty and stenting: A perfusion-computed tomography study[J]. Acta Radiol, 2015,56(6):754-760.
[10]	Duan G, Feng Z, Zhang L , et al. Solitaire stents for the treatment of complex symptomatic intracranial stenosis after antithrombotic failure: Safety and efficacy evaluation[J]. Neurointerv Surg, 2016,8(7):680-684.
[11]	Marks MP . Is there a future for endovascular treatment of intracranial atherosclerotic disease after stenting and aggressive medical management for preventing recurrent stroke and intracranial stenosis (SAMMPRIS)?[J]. Stroke, 2012,43(2):580-584.
[12]	Vajda Z, Guthe T, Perez MA , et al. Prevention of intracranial in-stent restenosis: Predilatation with a drug eluting balloon, followed by the deployment of a self-expanding stent[J]. Cardiovasc Intervent Radiol, 2013,36(2):346-352.
[13]	Hahnel S, Ringleb P, Hartmann M . Treatment of intracranial stenosis using the Neuroform stent system: Initial experience in five cases[J]. Neuroradiology, 2016,48(7):479-485.
[14]	Liu L, Ma N, Mo DP , et al. Enterprise stent in treatment of symptomatic complex intracranial atherosclerotic stenosis[J]. Chin J Stroke, 2017,12(7):592-597.
[15]	Liu L, Zhao X, Mo D , et al. Stenting for symptomatic intracranial vertebrobasilar artery stenosis: 30-day results in a high-volume stroke center[J]. Clin Neurol Neurosurg, 2016,4(143):132-138.
[16]	Krischek Ö, Miloslavski E, Fischer S , et al. A comparison of functional and physical properties of self-expanding intracranial stents[J]. Minim Invasive Neurosurg, 2011,54(1):21-28.
[17]	Shin YS, Kim BM, Suh SH , et al. Wingspan stenting for intracranial atherosclerotic stenosis: Clinical outcomes and risk factors for in-stent restenosis[J]. Neurosurgery, 2013,72(4):596-604.
[18]	Vajda Z, Schmid E, Guthe T , et al. The modified Bose method for the endovascular treatment of intracranial atherosclerotic arterial stenoses using the Enterprise stent[J]. Neurosurgery, 2012,70(1):91-101.

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