应用Enterprise支架治疗动脉粥样硬化性椎-基底动脉狭窄的探讨

doi:10.6040/j.issn.1671-7554.0.2015.153

摘要/Abstract

摘要： 目的探讨应用Enterprise支架治疗动脉粥样硬化性椎-基底动脉狭窄的安全性和有效性.方法回顾性分析2012年1月至2014年6月山东大学第二医院神经外科应用Enterprise支架治疗动脉粥样硬化性椎-基底动脉狭窄患者46例,患者术前至少提前3 d服用氯吡格雷(75 mg/d)和阿司匹林(300 mg/d)联合抗血小板治疗.记录患者各项临床指标,并于术后1、3、6、12个月进行临床及脑血管造影随访.结果 46例患者共计48处狭窄病变.其中男33例(71.7%),女13例(28.3%).病变位于基底动脉28处(58.3%),左侧椎动脉15处(31.3%),右侧椎动脉5处(10.4%).病变血管狭窄程度50%～70%共6处(33.3%),70%～99%共32处(66.7%).手术成功率100%.围手术期并发症4例(8.7%).术后6个月,35处病变获得造影随访,其中术后支架内再狭窄5例(14.3%).随访期发生与病变血管供血区一致的缺血事件5例(10.9%).结论应用Enterprise支架治疗动脉粥样硬化性椎-基底动脉狭窄安全有效,技术成功率高,并发症发生率较低.

关键词: 颅内支架, 介入治疗, 动脉粥样硬化, 狭窄, 椎-基底动脉

Abstract: Objective To assess the safety and efficacy of enterprise stent in the treatment of atherosclerotic vertebral-basilar arterial stenosis. Methods A retrospective study was performed in patients who received enterprise stent in the Department of Neurosurgery, Second Hospital of Shandong University during Jan. 2012 and June 2014. Patients were prescribed with medication of clopidogrel 75 mg/d and aspirin 300 mg/d at least 3 days preoperatively. The observation indexes, clinical follow-ups and digital subtraction angiography (DSA) performed in month 1, 3, 6 and 12 postoperatively were collected and reviewed. Results Of the 46 patients with 48 lesions, 33 (71.7%) were men and 13 (28.3%) were women, 28 lesions (58.3%) were at the basilar artery, 15 (31.3%) were at the left vertebral artery, and 5 (10.4%) were at the right vertebral artery. The technical success rate was 100%. Altogether 4 patients (8.7%) developed perioperative complications. DSA examination of 35 lesions 6 months postoperatively showed 5 cases (14.3%) had postoperative restenoses. And 5 (10.9%) ischemic events occurred during the follow-up. Conclusion Application of enterprise stent is safe and efficacious, with high technical success rate and low perioperative complication rate.

Key words: Enterprise stent, Vertebral-basilar artery, Stenosis, Atherosclerosis, Interventional therapy

中图分类号:

R651.1

王小飞, 王成伟, 王志刚, 丁璇, 王敏卿. 应用Enterprise支架治疗动脉粥样硬化性椎-基底动脉狭窄的探讨[J]. 山东大学学报（医学版）, 2015, 53(8): 44-48.

WANG Xiaofei, WANG Chengwei, WANG Zhigang, DING Xuan, WANG Minqing. Application of enterprise stent in atherosclerotic vertebral-basilar arterial stenosis[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(8): 44-48.

参考文献

[1] Derdeyn CP, Chimowitz MI, Lynn MJ, et al. Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial[J]. Lancet, 2014, 383(9914): 333-341.
[2] Peng T, Qian Z, Liu A, et al. Progressive occlusion of enterprise stent-assisted coiling of ruptured wide-necked intracranial aneurysms and related factors on angiographic follow-up: a single-center experience with 468 patients[J]. PLoS One, 2014, 9(3): 92407.
[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] Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. The EC/IC Bypass Study Group[J]. N Engl J Med, 1985, 313(19): 1191-1200.
[5] Bose A, Hartmann M, Henkes H, et al. A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study[J]. Stroke, 2007, 38(5): 1531-1537.
[6] 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.
[7] Mori T, Fukuoka M, Kazita K, et al. Follow-up study after intracranial percutaneous transluminal cerebral balloon angioplasty[J]. AJNR Am J Neuroradiol,1998,19(8): 1525-1533.
[8] Jiang WJ, Wang YJ, Du B, et al. Stenting of symptomatic M1 stenosis of middle cerebral artery: an initial experience of 40 patients[J]. Stroke, 2004, 35(6): 1375-1380.
[9] Park S, Kim JH, Kwak JK, et al. Intracranial stenting for severe symptomatic stenosis: self-expandable versus balloon-expandable stents[J]. Interv Neuroradiol, 2013, 19(3): 276-282.
[10] Kurre W, Berkefeld J, Brassel F, et al. In-hospital complication rates after stent treatment of 388 symptomatic intracranial stenoses: results from the INTRASTENT multicentric registry[J]. Stroke, 2010, 41(3): 494-498.
[11] Krischek O, Miloslavski E, Fischer S, et al. A comparison of functional and physical properties of self-expanding intracranial stents[Neuroform3, Wingspan, Solitaire, Leo+, Enterprise][J]. Minim Invasive Neurosurg, 2011, 54(1): 21-28.
[12] Turk AS, Levy EI, Albuquerque FC, et al. Influence of patient age and stenosis location on wingspan in-stent restenosis[J]. AJNR Am J Neuroradiol, 2008, 29(1): 23-27.
[13] Zaidat OO, Klucznik R, Alexander MJ, et al. The NIH registry on use of the Wingspan stent for symptomatic 70-99% intracranial arterial stenosis[J]. Neurology, 2008, 70(17): 1518-1524.
[14] Yue X, Xi G, Lu T, et al. Influence of residual stenosis on clinical outcome and restenosis after middle cerebral artery stenting[J]. Cardiovasc Intervent Radiol, 2011, 34(4): 744-750.
[15] 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.

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