药物洗脱球囊导管在治疗症状性颈内动脉颅内段狭窄的初步观察

Preliminary Observations of Drug-CoatedBalloon Catheter for Endovascular Treatment of Symptomatic Intracranial Internal Carotid Artery Stenosis

摘要: 目的：探索药物洗脱球囊导管应用于症状性颈内动脉颅内段粥样硬化性狭窄中的安全性及有效性。方法：回顾性连续纳入2022年1月至2023年9月青岛大学附属医院神经介入科收治药物洗脱球囊导管治疗的45例症状性颈内动脉颅内段粥样硬化性狭窄患者的临床资料，采用药物洗脱球囊对血管狭窄部位进行扩张治疗；药物球囊扩张前均先进行普通球囊进行预扩张。对患者围手术期并发症进行分析，并在术后的1个月、3个月和6个月进行临床随访。在术后6个月随访时，通过数字减影血管造影(Digital subtraction angiography, DSA)来评估患者靶病变血管的再狭窄状况。结果：45例患者顺利完成了药物洗脱球囊扩张手术，技术成功率100%。术中动脉夹层的发生率为26.7% (12/45)，均接受了补救性支架的置入。围手术期有2例(4.4%)患者出现了症状性颅内出血，无死亡及缺血性脑卒中等并发症发生。45例患者完成随访，无失访患者，并在术后6个月随访时完成了DSA复查，共2例(4.4%)患者出现再狭窄。随访期间未发生相关责任区域相关的缺血性事件，无相关死亡发生；患者术前中位改良Rankin评分(Modified Rankin Scale, mRS) 1 (1, 2)，术后1个月随访中位mRS评分为0 (0, 1)，术后3个月及术后6个月随访中位mRS评分均为0 (0, 0)，术后1个月，术后3个月、术后6个月mRS评分均低于术前，差异有统计学意义(P < 0.05)。结论：对于症状性颈内动脉颅内段粥样硬化性狭窄的患者，采用药物洗脱球囊进行治疗具有较高的安全性，并且可以改善患者的长期预后。

Abstract: Objective: To explore the safety and efficacy of drug-coated balloon (DCB) angioplasty for patients with symptomatic intracranial internal carotid artery (ICA) atherosclerotic stenosis. Methods: From January 2022 to September 2023, a retrospective study consecutively enrolled 45 patients with severe atherosclerotic stenosis of the intracranial ICA who were managed with DCBs in the Department of Neurological Intervention, Affiliated Hospital of Qingdao University were retrospectively reviewed. The drug-coated balloon was used to dilate the stenotic vascular segments, with a regular balloon pre-dilation performed before the drug balloon expansion. Perioperative complications were analyzed, and clinical follow-ups were conducted at one, three, and six months post-surgery. At the six-month follow-up, digital subtraction angiography (DSA) was used to assess the restenosis status of the target lesion vessels. Results: Drug-coated balloon dilatation was successfully completed in 45 patients with a 100% technical success rate. The incidence of intraoperative arterial entrapment was 26.7% (12/45), all of whom received remedial stent placement. Symptomatic intracranial hemorrhage occurred in 2 (4.4%) patients during the perioperative period, and no complications such as death or ischemic stroke occurred. Follow-up was completed in 45 patients, with no patients lost to follow-up, and DSA review was completed at the 6-month postprocedural follow-up, with restenosis occurring in a total of 2 (4.4%) patients. There were no ischemic events related to the area of responsibility and no related deaths occurred during the follow-up period; patients had a median Modified Rankin Scale (mRS) of 1 (1, 2) preoperatively, a median mRS score of 0 (0, 1) at the 1-month postoperative follow-up visit, and a median mRS score of 0 (0, 0) at the 3-month postoperative and 6-month postoperative visits. The mRS scores at one, three, and six months post-surgery were all lower than the preoperative score, with statistically significant differences (P < 0.05). Conclusions: In patients with symptomatic atherosclerotic stenosis of the intracranial ICA, treatment with DCB dilatation has a high safety profile and improves the long-term prognosis of the patient.