Clinical and basic research of the endovascular therapy for intracranial atherosclerotic lesion

颅内动脉粥样硬化病变血管内治疗的临床与基础研究

• 批准号: 11671381
• 负责人: TERADA Tomoaki
• 金额: $ 2.24万
• 依托单位: Wakayama Medical College
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1999
• 资助国家: 日本
• 起止时间: 1999 至 2000
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-11671381/
• 关键词: intracranial artery; stent; atherosclerosis; perforating artery; arteriosclerosis; PTA; stent; intracranial artery

Endovascular therapy for intracranial atherosclerotic stenosis is novel treatment recently developed. However, there still exist several problems to be solved. We studied long term follow-up results of percutaneous transluminal angioplasty and effect of stenting for this disorder in clinical cases. In basic research, the patency of the perforating artery of the intracranial artery was studied when intracranial stenting was performed.(1)Clinical research : Endovascular therapy was performed in 45 cases with intracranial atherosclerotic stenosis. 44 cases were successfully treated with endovascular therapy. In ten cases, stenting was tried and successful results were obtained in eight cases but failed in two cases due to the tortuosity of the artery. Significant dilatation was obtained in stent group(80 % stenosis to 4 % stenosis)compared with PTA group(75% stenosis to 27 % stenosis). Restenosis also tends to be reduced in stent group without statistical significance. Two complications w … More ere encountered in stent-tried group, one was stent migration which needed retrieval with a snare wire, and the other was stent thrombosis which was terated with emergent PTA and fibrinolysis. Two hemorrhagic complication appeared in PTA group, one hyperperfusion hemorrhage and one rupture of the associated aneurysm. Four ischemic complication occurred in 45 patients but two were transient and two minor stroke. No new lesion-related ischemic stroke was not encountered in mean 29-months follow-up period. Endovascular therapy was effective for stroke prevention, although there exist 9% procedure-related complication.(2)Basic research : In rabbits, their abdominal aorta is nearly 3 mm in diameter and lumbar arteries, 500 microns in average diameter, merges from the aorta. This anatomical situation is very similar to that of human intracranial artery, such as the middle cerebral artery or basilar artery. We deployed stents into the rabbits' abdominal aorta to cross the lumbar arteries. The patency of the lumbar artery was examined angiography as well as scanning electron microscopy three months after the treatment in eight rabbits. In all rabbits, lumbar arteries were kept patent and endothelial-like cells covered the strut. Less

颅内动脉粥样硬化性狭窄的血管内治疗是最近开发的新型治疗方法。然而，仍然存在一些问题有待解决。我们研究了经皮腔内血管成形术的长期随访结果以及临床病例中支架置入术对该疾病的效果。基础研究主要研究颅内支架置入术时颅内动脉穿支动脉的通畅情况。(1)临床研究:对45例颅内动脉粥样硬化性狭窄患者进行了血管内治疗。 44例血管内治疗成功。 10例尝试了支架置入术，其中8例获得成功，但2例因动脉迂曲而失败。与PTA组（75%狭窄至27%狭窄）相比，支架组（80%狭窄至4%狭窄）获得了显着的扩张。支架组的再狭窄也趋于减少，但没有统计学意义。支架试验组出现两种并发症，一是支架移位，需要用圈套器钢丝回收，二是支架血栓，需要紧急PTA和纤溶治疗。 PTA组出现2种出血并发症，1种是过度灌注出血，1种是相关动脉瘤破裂。 45 名患者出现 4 项缺血性并发症，其中 2 例为短暂性并发症，2 例为轻微中风。在平均 29 个月的随访期内，没有出现新的与病变相关的缺血性中风。血管内治疗对于预防中风是有效的，尽管存在9％的手术相关并发症。(2)基础研究：兔子的腹主动脉直径接近3毫米，腰动脉平均直径500微米，从主动脉汇合。这种解剖情况与人类的颅内动脉，如大脑中动脉或基底动脉非常相似。我们将支架植入兔子的腹主动脉以穿过腰动脉。治疗三个月后，对八只兔子进行血管造影和扫描电子显微镜检查腰动脉的通畅情况。在所有兔子中，腰动脉均保持开放，并且内皮样细胞覆盖支柱。较少的

项目成果

寺田友昭 他: "Neurosurgery Headline 5 脳血管の再建"三輪書店. 163(70-77) (1999)

Tomoaki Terada 等：《神经外科头条 5 脑血管重建》Miwa Shoten 163(70-77) (1999)。

Terada T, et al: "Treatment of restenosis after percutaneous transluminal angioplasty for internal carotid stenosis."Neuroradiology. 42. 296-301 (2000)

Terada T 等人：“颈内动脉狭窄经皮腔内血管成形术后再狭窄的治疗”。神经放射学。

Terada T. et al: "Measurement of the intracranial arterial wedge pressure in cases of acute cerebral arterial occlusion to determine the indication of intraarterial thrombolytic therapy."Interventional Neuroradiology. 6(Suppl1). 213-215 (2000)

Terada T. 等人：“在急性脑动脉闭塞的情况下测量颅内动脉楔压，以确定动脉内溶栓治疗的适应症。”介入神经放射学。

Terada T: "Measurement of the intracranial arterial wedge pressure in cases of acute cerebral arterial occlusion to determine the indication of intraarterial thrombolytic therapy"Interventional Neuroradiology. 6(Suppl 1). 213-215 (2000)

Terada T：“急性脑动脉闭塞病例中颅内动脉楔压的测量以确定动脉内溶栓治疗的指征”介入神经放射学。

Terada T: "Endovascular surgery for internal carotid stenoses. Results of PTA vs.Stenting."Interventional Neuroradiology. 6(Suppl 1). 233-235 (2000)

Terada T：“颈内动脉狭窄的血管内手术。PTA 与支架置入术的结果。”介入神经放射学。