2018 年第 12 期 第 13 卷

血管内支架介入与药物治疗症状性颅内动脉粥样硬化性狭窄的临床效果

Effects of intravascular stent intervention and medication on symptomatic intracranial atherosclerotic stenosis

作者：王菁解燕昭刘云娥秦世杰朱倩

英文作者：

单位：050011石家庄市第一医院神经内科（王菁、刘云娥、秦世杰、朱倩）；050000石家庄长城中西医结合医院心血管内科（解燕昭）

英文单位：

关键词：脑梗死；症状性颅内动脉粥样硬化性狭窄；血管成形术；脑血流动力学

英文关键词：

• 摘要：

• 【摘要】目的    探讨血管内支架介入与药物治疗症状性颅内动脉粥样硬化性狭窄的临床效果。方法    选取2014年7月至2015年6月石家庄市第一医院神经内科诊断为症状性颅内动脉粥样硬化性狭窄患者55例，依据临床治疗方法分为介入组（23例）与药物组（32例）。介入组采用血管内支架置入治疗，药物组采用规范药物治疗，连续随访观察3年。比较2组患者治疗前及治疗后3、14 d美国国立卫生研究院卒中量表（NIHSS）评分。治疗前及治疗后10 d采用经颅多普勒超声检查大脑中动脉狭窄段收缩期峰值流速（PSV）、搏动指数，采用CT脑灌注成像分析局部脑血流速度（rCBF）、局部脑血容积（rCBV）、平均通过时间（MTT）。观察2组患者治疗后7 d、1年、3年临床不良事件发生率。结果    2组患者治疗后10 d PSV、搏动指数均较治疗前明显下降，介入组明显低于药物组［（96±22）cm/s比（136±18）cm/s、（0.85±0.23）比（1.42±0.31）］（均P＜0.05）。介入组治疗后10 d患侧rCBF、rCBV较治疗前明显增加，MTT较治疗前明显降低（均P＜0.05）；药物组治疗前后患侧rCBF、rCBV、MTT差异均无统计学意义（均P＞0.05）；介入组治疗后10 d患侧rCBF、rCBV明显高于药物组［（524±102）ml/min比（426±99）ml/min、（23.8±2.9）ml/g比（18.7±2.5）ml/g］，MTT明显低于对照组［（3.5±0.8）s比（6.0±1.0）s］（均P＜0.05）。治疗后3 d，介入组NIHSS评分明显低于药物组［（4.3±2.0）分比（9.1±2.3）分］（P＜0.05）；治疗后14 d，2组NIHSS评分差异无统计学意义（P＞0.05）。介入组治疗后7 d、1年、3年临床不良事件发生率均明显低于药物组（均P＜0.05）。结论    颅内动脉支架介入治疗可以明显改善症状性颅内动脉粥样硬化性狭窄患者的临床神经缺损症状，扩张血管狭窄段，增加患侧脑组织血液供应，减少临床不良事件发生。

• 【Abstract】Objective    To analyze the effects of intravascular stent intervention and medication on symptomatic intracranial atherosclerotic stenosis（sICAS）. Methods    Fifty-five patients with sICAS were enrolled from July 2014 to June 2015 in the First Hospital of Shijiazhuang. According to the different therapeutic Methods, they were divided into intravascular intervention group（n＝23） and medication group（n＝32）. National Institutes of Health Stroke Scale（NIHSS） was assessed before and 3, 14 d after treatment. Transcranial Doppler sonography and CT perfusion imaging were performed before and 10 d after treatment to analyze the peak systolic velocity（PSV） and pulsatility index（PI） of middle cerebral artery stenosis, regional cerebral blood flow velocity（rCBF）, regional cerebral blood volume（rCBV） and mean transit time（MTT）. Clinical adverse events were observed in 7 d, 1 year and 3 years after treatment. Results    At 10 d after treatment, PSV and PI significantly decreased in both groups; PSV and PI in intravascular intervention group were lower than those in medication group［（96±22）cm/s vs （136±18）cm/s, （0.85±0.23） vs （1.42±0.31）］（P＜0.05）. After treatment, rCBF and rCBV of stenosis significantly increased and MTT significantly decreased in intravascular intervention group（P＜0.05）; rCBF, rCBV and MTT showed no significant change in medication group（P＞0.05）; rCBF and rCBV in intravascular intervention group were higher and MTT was lower than those in medication group［（524±102）ml/min vs （426±99）ml/min, （23.8±2.9）ml/g vs （18.7±2.5）ml/g, （3.5±0.8）s vs （6.0±1.0）s］（P＜0.05）. At 3 d after treatment, NIHSS score in intravascular intervention group were lower than that in medication group［（4.3±2.0） vs （9.1±2.3）］（P＜0.05）. At 14 d after treatment, there was no significant difference of NIHSS score between groups（P＞0.05）. Incidences of clinical adverse events in 7 d, 1 year and 3 years in intravascular intervention group were lower than those in medication group（P＜0.05）. Conclusion    Intracranial artery stent intervention can effectively improve neurologic defect symptoms, dilate stenosis, increase brain blood flow and reduce clinical adverse events in patients with sICAS.