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目的 通过应用药物洗脱支架(CypherTM)治疗症状性颅内动脉狭窄的临床效果观察,以探讨防止再狭窄的机制。方法 选择症状性颅内动脉狭窄4例患者,1例右颈内动脉C4段重度狭窄伴左椎动脉开口重度狭窄,2例椎动脉V4段重度狭窄,1例右侧大脑中动脉M1段重度狭窄,病变狭窄程度经DSA造影证实均在90％以上,狭窄长度为13-15 mm。在全身麻醉下,以Seldinger’s技术行右股动脉穿刺,置入6 F动脉鞘,使用6 F Envoy导引导管,在微导丝引导下将CypherTM支架准确定位后释放。 结果 DSA造影证实:1例右颈内动脉C4段伴左椎动脉开口狭窄,管径恢复正常,2例椎动脉V4段及1例右侧大脑中动脉M1段狭窄程度减少90％以上。4例患者临床症状消失。结论 药物洗脱支架在治疗冠状动脉狭窄中已有应用,治疗症状性颅内动脉狭窄是一种新的尝试,临床效果及能否预防再狭窄,尚需进一步随访。
Objective To investigate the clinical effects of symptomatic intracranial arterial stenosis (DES) by using drug-eluting stent (CypherTM) to explore the mechanism of preventing restenosis. Methods Four patients with symptomatic intracranial arterial stenosis were selected. One patient had severe C4 stenosis of the right internal carotid artery with severe stenosis of left vertebral artery, 2 severe stenosis of V4 segment of vertebral artery, and 1 severe stenosis of M1 segment of right middle cerebral artery The degree of stenosis was confirmed by DSA angiography more than 90%, the length of stenosis was 13-15 mm. Under general anesthesia, right femoral artery puncture was performed with Seldinger’s technique. 6 F arterial sheath was implanted, and 6 F Envoy guided catheter was used to accurately locate and release the Cypher stent under the guide of micro-guide wire. Results DSA angiography confirmed that the C4 segment of the right internal carotid artery had an open stenosis of the left vertebral artery with normal diameter. The stenosis degree of M1 segment in 2 cases of V4 segment of the vertebral artery and right middle cerebral artery decreased by 90% or more. 4 patients disappeared clinical symptoms. Conclusion The drug-eluting stent has been used in the treatment of coronary artery stenosis. It is a new attempt to treat symptomatic intracranial arterial stenosis. It is necessary to further investigate the clinical efficacy and whether it can prevent restenosis.