Failure of Primary Percutaneous Angioplasty and Stenting in the Prevention of Ischemia in Moyamoya Angiopathy
Failure of Primary Percutaneous Angioplasty and Stenting in the Prevention of Ischemia in Moyamoya Angiopathy
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DOI：
10.1159/000320253
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发表时间：
2011-01-01
影响因子：
2.9
通讯作者：
Steinberg, Gary K.
中科院分区：
文献类型：
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作者：
Khan, Nadia;Dodd, Robert;Steinberg, Gary K.
背景：烟雾病（Moyamoya disease，MMD）是一种累及颅内近端血管的特发性进行性动脉病。迄今为止，只有4例病例报告颅内血管成形术或支架植入术治疗这种疾病。我们介绍了5例血管成形术和/或支架植入术失败的MMD成人患者，尽管进行了血管内治疗，但仍有症状，或在血管造影术上出现复发症状和狭窄/闭塞复发，需要随后进行颅外-颅内血运重建。研究方法：5例接受血管成形术或支架植入术血管内治疗的成人MMD患者被转诊到外院接受进一步评价和治疗。从临床转诊记录和血管造影或报告中收集数据。所有患者均接受了重复的6血管脑血管造影，以评估疾病的程度和既往血管内治疗的结果。结果：所有5例患者均接受了6次血管内手术。2例患者（3支动脉）行颈内动脉（ICA）球囊血管成形术和Wingspan支架置入术。1例患者行ICA-M1血管成形术，未植入支架。2例患者接受了M1血管成形术和Wingspan支架植入术。所有患者在治疗后均发生了反复短暂性脑缺血发作，可归因于血管内治疗的血管区域。3例患者在平均4个月（范围= 2 - 6）时进行了重复血管内治疗。2例患者由于血管成形术/支架置入血管中的疾病进展而继续接受第三次血管内治疗。首次血管内治疗后症状复发的平均时间为1.8个月（0 - 4个月）。转诊至我们机构的随访血管造影显示3例患者的支架内再狭窄率为70 - 90%，1例患者发生闭塞。由于症状持续存在，所有患者均进行了脑血运重建。结论：MMD是一种进行性血管病。血管成形术和支架植入术可以暂时改善脑血流并减少脑缺血事件，但似乎不持久，也不能长期预防未来的缺血事件。版权所有（C）2010 S. Karger AG，巴塞尔
Background: Moyamoya disease (MMD) is an idiopathic progressive arteriopathy affecting the proximal intracranial vasculature. To date only 4 case reports on intracranial angioplasty or stenting as treatment of this disease exist. We present 5 adult patients with MMD who failed angioplasty and/or stenting who remained symptomatic despite endovascular treatment or presented with recurrent symptoms and recurrence of stenosis/occlusion on angiography requiring subsequent extracranial-intracranial revascularization. Methods: Five adult MMD patients who underwent endovascular treatment with angioplasty or stenting were referred for further evaluation and treatment from outside hospitals. Data were collected from clinical referral notes and angiograms or reports. All patients underwent repeat 6-vessel cerebral angiography to assess the extent of disease and results of prior endovascular treatment. Results: Six endovascular procedures were performed in all 5 patients. Internal carotid artery (ICA) balloon angioplasty and Wingspan stenting was performed in 2 patients (3 arteries). One patient had ICA-M1 angioplasty without stenting. Two patients had M1 angioplasty and Wingspan stenting. All patients developed repeat transient ischemic attacks following treatment attributable to the vascular territories of endovascular treatment. Repeat endovascular treatment was performed in 3 patients at a mean of 4 months (range = 2-6). Two went on to a third endovascular treatment due to progression of disease in the angioplastied/stented vessel. The average time of symptom recurrence after initial endovascular therapy was 1.8 months (0-4 months). Follow-up angiography when referred to our institution demonstrated 70-90% instent restenosis of the stented vessel in 3 and occlusion in 1 patient. Due to persistence of symptoms cerebral revascularization was performed in all patients. Conclusion: MMD is a progressive angiopathy. Angioplasty and stenting may temporarily improve the cerebral blood flow and decrease cerebral ischemic events but do not appear to be durable nor provide long-term prevention against future ischemic events. Copyright (C) 2010 S. Karger AG, Basel