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目的探讨症状性大脑中动脉狭窄球嚢扩张血管内支架成形术的疗效和安全性。方法将50例症状性大脑中动脉M1段狭窄[均经数字减影血管造影技术(DSA)证实,狭窄率>50%]的患者按随机数字表法分为治疗组和对照组,每组25例。治疗组给予球嚢扩张血管内支架成形术,对照组单纯给予内科药物治疗。观察治疗组手术成功率、术后动脉残余狭窄率及并发症发生率。比较2组患者治疗6个月后缺血性卒中的再发生率、美国国立卫生研究院卒中量表(NIHSS)评分及Barthel指数的改善情况。结果治疗组25例患者手术均成功,手术成功率为100.0%。支架置入后狭窄程度均明显改善,狭窄程度由术前的(83.64±13.25)%下降至(12.19±4.86)%,远端血管无新梗死灶,无手术期死亡及严重神经系统并发症发生。均随访6个月,无脑缺血症状发生。18例患者复查DSA,1例出现大脑中动脉再狭窄,狭窄率为5.6%。对照组随访6个月,7例短暂性脑缺血发作(TIA)患者仍发作2次,其中2例患者出现新的脑梗死病灶。治疗组和对照组6个月后缺血性卒中的再发生率分别为0.0%及8.0%,NIHSS评分分别为(3.92±1.48)分及(6.27±3.12)分,Barther指数分别为80.22±20.12及65.78±24.25,2组比较差异均有统计学意义(均P<0.05)。结论采用球嚢扩张血管内支架成形术治疗症状性大脑中动脉M1段中重度狭窄,是一种有效、可行的方法,其效果优于单纯内科药物治疗。
Objective To investigate the efficacy and safety of symptomatic middle cerebral artery stenosis with balloon dilatation and endovascular stenting. Methods Fifty patients with symptomatic middle cerebral artery stenosis [all confirmed by digital subtraction angiography (DSA), stenosis rate> 50%] were divided into treatment group and control group according to random number table example. The treatment group was given dilated balloon angioplasty, the control group was given medical treatment alone. The success rate of operation, residual stenosis rate and complication rate in the treatment group were observed. Recurrence rates of ischemic stroke, the National Institutes of Health Stroke Scale (NIHSS) score and the Barthel Index were compared between the two groups after 6 months of treatment. Results In the treatment group, 25 patients were successfully operated and the successful rate was 100.0%. The degree of stenosis was significantly improved after stent implantation. The degree of stenosis decreased from (83.64 ± 13.25)% to (12.19 ± 4.86)% preoperatively. There was no new infarction in distal vessel, no operative mortality and serious neurological complications . All patients were followed up for 6 months without symptoms of cerebral ischemia. DSA was reviewed in 18 patients, and in the other 1, middle cerebral artery restenosis occurred. The stenosis rate was 5.6%. The control group was followed up for 6 months. Seven patients with transient ischemic attack (TIA) were still attacked 2 times, of which 2 patients showed new infarction. The recurrence rates of ischemic stroke in treatment group and control group after 6 months were 0.0% and 8.0%, NIHSS score was (3.92 ± 1.48) points and (6.27 ± 3.12) points respectively, Barther index was 80.22 ± 20.12 And 65.78 ± 24.25, the difference between the two groups was statistically significant (P <0.05). Conclusions The treatment of severe stenosis of symptomatic middle cerebral artery (M1) segment by balloon dilatation and endovascular angioplasty is an effective and feasible method, which is superior to simple medical treatment alone.