颅内动脉粥样硬化性狭窄的药物涂层球囊安全性评估:前循环与后循环的比较
Safety assessment of drug-coated balloons for intracranial atherosclerotic stenosis:The anterior circulation versus the posterior circulation
罗继昌 1黄凯勋 2宫昊志 1王韬 1焦力群 3陈赛安 4张桃红4
作者信息
- 1. 首都医科大学宣武医院神经外科,北京 100053;中国国际神经外科研究所,北京 100053
- 2. 中山大学第八附属医院,深圳 518033
- 3. 首都医科大学宣武医院神经外科,北京 100053;中国国际神经外科研究所,北京 100053;首都医科大学宣武医院介入放射科,北京 100053
- 4. 北京科技大学计算机与通信工程学院,北京 100083
- 折叠
摘要
目的 药物涂层球囊(DCB)血管成形术是治疗颅内动脉粥样硬化性狭窄(ICAS)患者的一种潜在方法.由于前、后循环的血管解剖结构不同,围手术期的并发症也各不相同.本研究旨在比较DCB血管成形术治疗前、后循环ICAS的疗效和安全性.方法 这项研究将纳入在首都医科大学宣武医院接受DCB血管成形术的症状性重度ICAS患者.根据责任病变的位置,参与者被分为两组,前循环(Ac)组和后循环(Pc)组.两组患者的基线人口统计学、斑块特征和临床结果进行了比较.结果 共有94名符合条件的患者被纳入本次分析(Ac组53例,Pc组41例).两组患者围手术期的卒中或死亡风险无明显差异(Ac:Ac:5.7％[3/53]vs.Pc:4.9％2/41];OR 2.91,95％置信区间[CI]0.33～25.99).经多因素分析校正后,Ac组发生医源性动脉夹层(Ac:45.3％[24/53]vs.Pc:12.2％[5/41];aOR 4.72,95％CI 1.49～14.90)和补救性支架植入(Ac:26.4％[14/53]vs.Pc:2.4％[1/41];aOR 14.71,95％CI 1.61～134.37)的风险明显高于Pc组.结论 DCB血管成形术治疗前循环和后循环ICAS的安全性相当.但前循环中的DCB可能会导致更多的动脉夹层和支架补救治疗.为进一步证实ICAS治疗策略,有必要进行长期随访和进一步研究.
Abstract
Objectives Drug-coated balloon(DCB)angioplasty is a potential treatment for intracranial atherosclerotic stenosis(ICAS)patients.Since the vascular anatomy differed in anterior and posterior circulation,the perioperative complications tend to vary.This study aimed to compare the therapeutic effect and safety of DCB angioplasty in ICAS treatment in both anterior and posterior circulations.Methods This analysis included symptomatic severe ICAS patients who underwent DCB angioplasty at Xuanwu Hospital,Capital Medical University.Participants were divided into two groups based on the location of the culprit lesion,the anterior circulation(Ac)group and posterior circulation(Pc)group.Baseline demographics,plaque features,and clinical outcomes were compared between the two groups.Results A total of 94 eligible patients were included in this analysis(53 cases in Ac group and 41 cases in Pc group).There was no significant difference between the two groups in terms of perioperative risks of any stroke or death(Ac:5.7％[3/53]vs.Pc:4.9％[2/41];OR 2.91,95％confidential interval[CI]0.33～25.99).After adjustment,the Ac group had a significantly higher risks of iatrogenic arterial dissection(Ac:45.3％[24/53]vs.Pc:12.2％[5/41];aOR 4.72,95％CI 1.49～14.90)and remedial stenting(Ac:26.4％[14/53]vs.Pc:2.4％[1/41];aOR 14.71,95％CI 1.61～134.37)than the Pc group.Conclusion The safety of DCB angioplasty for treating ICAS in both anterior and pos-terior circulations is comparable.However,DCB in anterior circulation may lead to more arterial dissec-tions and rescue stenting.Long-term follow-up and further studies were necessary to further confirm ICAS treatment strategies.
关键词
颅内动脉粥样硬化/药物涂层球囊/高分辨率磁共振成像/卒中Key words
intracranial atherosclerosis/drug-coated balloon/high-resolution magnetic resonance ima-ging/stroke引用本文复制引用
出版年
2024
NETL
NSTL
万方数据