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目的探讨症状性颅内动脉狭窄血管内支架成形术围手术期并发症及其相关危险因素。方法回顾性分析2006年11月 2009年11月,哈尔滨医科大学第一临床医学院单中心完成的症状性颅内动脉狭窄支架成形术127例(责任血管狭窄率为50%～99%)的临床资料。以应用球囊扩张支架的前20例和自膨式支架的前20例为界,将病例分为非成熟期和成熟期。观察术中及术后7 d所有不良事件,并分析其相关危险因素。结果①127例中,10例(7.9%)发生围手术期并发症。其中出血性卒中3例(2.4%),缺血性卒中6例(4.7%,4例为小卒中),短暂性脑缺血发作1例(0.8%)。死亡3例(2.4%),重残2例。②非成熟期患者并发症发生率(17.5%,7/40)高于成熟期患者(3.5%,3/87),P<0.05。性别、年龄、狭窄程度、支架类型及病变位置对并发症无影响。剔除手术操作因素造成的4例(均在非成熟期),后循环病变的并发症发生率(11.1%,5/45)高于前循环(1.2%,1/82),P<0.05。③分层分析显示,应用球囊扩张支架,后循环病变并发症发生率(25.0%,4/16)高于前循环病变(1.7%,1/59),P<0.05;应用自膨式支架,后循环病变并发症发生率(6.9%,2/29)低于球囊扩张支架(25%,4/16),但差异无统计学意义。结论在术者接受严格训练的前提下,血管内支架成形术是相对安全的;处理后循环病变的相对风险较高,而使用自膨式支架可能会降低其风险。
Objective To investigate perioperative complications and related risk factors of intravascular angioplasty in patients with symptomatic intracranial arterial stenosis. Methods Retrospective analysis of November 2006 in November 2009, Harbin Medical University First Clinical Center completed a single center of symptomatic intracranial arterial stenosis stent in 127 cases (responsible for vascular stenosis rate of 50% to 99%) of the clinical data. In order to apply the first 20 cases of balloon dilatation stent and the first 20 cases of self-expanding stent as the boundary, the cases were divided into non-maturity and maturity. All the adverse events during and after operation were observed and their related risk factors were analyzed. Results ①127 cases, 10 cases (7.9%) perioperative complications occurred. Among them, 3 had hemorrhagic stroke (2.4%), 6 had ischemic stroke (4.7%, 4 had minor stroke) and 1 had transient ischemic attack (0.8%). 3 cases died (2.4%), severe disability in 2 cases. ② The incidence of complications in non-mature patients (17.5%, 7/40) was higher than that in mature patients (3.5%, 3/87), P <0.05. Gender, age, degree of stenosis, stent type, and location of the lesion had no effect on the complication. The incidence of complications of retroperitoneal circulation (11.1%, 5/45) was higher than that of the anterior circulation (1.2%, 1/82), except P <0.05. ③ stratified analysis showed that the application of balloon dilatation stent, the incidence of complications of retroperitoneal circulation (25.0%, 4/16) was higher than the former (1.7%, 1/59), P <0.05; , And the incidence of complications of retroperitoneal circulation (6.9%, 2/29) was lower than that of balloon-expandable stent (25%, 4/16). However, the difference was not statistically significant. Conclusion Under the premise of rigorous training, endovascular stenting is relatively safe; the relative risk of recurrent disease after treatment is high, and the use of self-expanding stents may reduce the risk.