球囊扩张支架与自膨式支架治疗侧支循环欠佳的症状性颅内动脉狭窄的临床研究

Balloon-Mounted Stent versus Self-Expanding Stent for Symptomatic Intracranial Artery Stenosis Combined with Poor Collateral Circulation

摘要: 目的：比较球囊扩张支架与自膨式支架治疗侧支循环欠佳的症状性颅内动脉狭窄患者1年的临床疗效。方法：收集中国20家医院2013年9月至2015年1月接受球囊扩张支架或自膨式支架的258名症状性颅内动脉狭窄合并侧支循环不良患者为研究对象，对患者基线特征及临床疗效进行评估。结果：总体平均狭窄程度由支架植入前的83.73 ± 10.40%降至支架植入后的8.5 ± 7.96%。自膨式支架治疗的患者接受全身麻醉的比例高于球囊扩张支架治疗的患者(81.5% VS 62.7%, P = 0.001)，且手术时间更长(93.53 ± 24.11 min VS 68.09 ± 16.74 min, P < 0.001)。使用自膨式支架治疗的患者需要更长和更大直径的支架(分别为14.44 ± 3.09 mm VS 9.67 ± 2.57 mm，P < 0.001，3.06 ± 0.47 mm VS 2.69 ± 0.27 mm，P < 0.001)。自膨式支架患者的残余狭窄率高于球囊扩张支架患者(11.36 ± 8.26% VS 5.99 ± 6.48%，P < 0.001)，两组中使用自膨式支架的患者再狭窄发生率高(11/124 VS 21/112，P=0.027)，且再狭窄程度也较球囊扩张支架高(36.2 ± 18.33 VS 48.5 ± 24.51%, P < 0.001)。1年随访期间，两组出现缺血性卒中、出血性卒中、短暂性脑缺血发作、死亡的发生率无显著差异(分别是P = 0.722、0.105、0.725、1.000)。结论：对于严重颅内动脉狭窄且合并侧支循环不良的患者，进行支架植入术相对安全。球囊扩张支架较自膨式支架的手术时间更短，发生再狭窄的机率及再狭窄程度更低，但两者1年随访结局无明显差异。

Abstract: Objective: To compare the 1-year clinical outcome of balloon-mounted stent versus self-expanding stent in the treatment of symptomatic intracranial artery stenosis combined with poor collateral circulation. Method: A total of 258 patients with symptomatic intracranial artery stenosis combined with poor collateral circulation were enrolled in the study. Balloon-mounted stent and self-expanding stent were selected according to the vascular conditions of the patients, then the baseline characteristics and clinical outcome of the patients were compared. Results: The overall mean degree of stenosis decreased from 83.73 ± 10.40% to 8.5 ± 7.96%. Patients treated with self-expanding stent were more likely to receive general anesthesia (81.5% vs 62.7%, P = 0.001), and the operation time was longer than balloon-mounted stent (93.53 ± 24.11 min vs 68.09 ± 16.74 min, P < 0.001). Patients treated with self-expanding stent need longer and larger diameter stents than balloon-mounted stent (14.44 ± 3.09 mm vs 9.67 ± 2.57 mm, P < 0.001, 3.06 ± 0.47 mm vs 2.69 ± 0.27 mm, respectively, P < 0.001), the residual stenosis rate of patients with self-expanding stent was higher than patients treated with balloon-mounted stent (11.36 ± 8.26% vs 5.99 ± 6.48%, P < 0.001), and the restenosis rate of patients with self-expanding stent was higher than that patients treated with balloon-mounted stent (11/124 vs 21/112, P = 0.027), the restenosis degree was also higher than the patients treated with balloon-mounted stent (36.2 ± 18.33 vs 48.5 ± 24.51%, P < 0.001). The rates of stroke, transient ischemic attack or death at 1-year follow-up were not significantly different between two groups (P = 0.722, 0.105, 0.725 and 1.000, respectively). Conclusions: For patients with severe intracranial artery stenosis combined with poor collateral circulation, stent implantation can be performed safely. Compared with self-expanding stent, the operation time of balloon expanding stent is shorter, and the probability and degree of restenosis are lower, but there is not any significant difference in 1-year follow-up results between the 2 groups.