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

血管内治疗颅内动脉粥样硬化性狭窄是近年来发展起来的一种新型治疗方法。然而，仍存在一些问题需要解决。我们研究了经皮腔内血管成形术的长期随访结果和临床病例中支架置入术的效果。在基础研究中，研究颅内支架置入时颅内动脉穿通动脉的通畅情况。(1)临床研究：对45例颅内动脉粥样硬化性狭窄患者行血管内治疗。44例经血管内治疗成功。在10例患者中，8例成功，2例因动脉扭曲而失败。与PTA组（狭窄75% ~ 27%）相比，支架组（狭窄80% ~ 4%）有明显的扩张。支架组再狭窄也有减少的趋势，但无统计学意义。支架组出现两种并发症，一种是支架移位，需要用钢丝回收；另一种是支架血栓形成，需要紧急PTA和纤维蛋白溶解。PTA组出现2例出血并发症，1例高灌注出血，1例相关动脉瘤破裂。45例患者发生4例缺血性并发症，其中2例为短暂性卒中，2例为轻微卒中。在平均29个月的随访期间，未发生新的病变相关缺血性脑卒中。血管内治疗对卒中预防是有效的，尽管存在9%的手术相关并发症。(2)基础研究：家兔的腹主动脉直径近3毫米，腰椎动脉平均直径500微米，从主动脉合并。这种解剖情况与人的颅内动脉，如大脑中动脉或基底动脉非常相似。我们将支架置入兔子的腹主动脉，穿过腰动脉。治疗3个月后，对8只兔腰动脉进行血管造影和扫描电镜检查。在所有家兔中，腰动脉保持通畅，内皮样细胞覆盖支架。少

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