| Objective:To compare the efficacy and incidence of complications in the treatment of severe symptomatic MCA stenosis with balloon dilation alone and self-inflating stent implantation,and to explore the strategies,risks and clinical outcomes of enhanced drug based MCA in the treatment of severe MCA stenosis.Materials and Methods:A retrospective analysis of 83 patients admitted to the Second Hospital of Dalian Medical University from September 2018to June 2022 with cerebral infarction and transient ischemic attack(TIA)who underwent intravascular intervention after DSA examination confirmed severe mid-brain artery stenosis(stenosis rate 7099%).Patients and family members knowingly chose to undergo simple balloon dilation or self-inflating stent insertion.All the surgeries were performed in our catheterized room.All enrolled patients were followed up 14 days,1 month,and 6 months after surgery to record NIHSS scores and mRS scores,and were required to review DSA or CTA 6 months after surgery.The surgical success rate,target residual stenosis rate,incidence of perioperative complications,restenosis,recurrence of symptoms and prognosis 14 days,1 month and 6 months after surgery were compared.The effect of different vascular complexity on complications and prognosis and risk factors for restenosis were also analyzed and discussed.Results:1.There were no statistically significant differences in general data such as sex,age,smoking history,hypertension,diabetes,hyperlipidemia,coronary heart disease,preoperative NIHSS score,preoperative mRS score,preoperative mRS score,prior cerebrovascular surgery history,preoperative stenosis rate,etc.(P>0.05),and drinking history and duration of surgery(P<0.05).2.In the balloon and stent groups,the surgical success rates were 100%and 97.8%,respectively.The mean residual stenosis rate was(22.03 ± 13.51 vs 11.96 ± 8.33%),(P<0.01),perioperative complications were(2.7 vs 10.8%),(P>0.05),postoperative restenosis was(24.3 vs 15.2%),(P>0.05),and symptom recurrence was(21.13%),respectively.3.Comparisons of NIHSS scores and mRS scores between the two groups were statistically significant(P<0.05).The percentage of patients with effective neurological improvement during clinical follow-up 14 days after surgery was[86.5%vs 71.7%],(P>0.05).MRS≤2 was statistically significant compared to the balloon group(94.6%,100%,97.3%,stents,86.9%,and 91.3%,respectively).4.The incidence of perioperative complications was 0%,4.9%,and 25%for Mori A,Mori B,and Mori C,respectively,and the incidence of postoperative restenosis was 3.8%,19.5%,and 43.8%,respectively,and the recurrence of symptoms was 0%,21.9%,and 31.3%.Both differences were statistically significant(P<0.05).Prognosis of both procedures was analyzed in the Mori subgroup,and there was no statistically significant difference between perioperative complications,TIA recurrence,and restenosis in the balloon and stent groups in Mori A and MoriC(P>0.05).The difference in postoperative TIA recurrence was statistically significant in the balloon and stent groups in MoriB(P<0.05).5.Postoperative restenosis was significantly associated with diabetes[OR=6.316,95%CI(1.193,33.438)]and intracranial multiple vessel stenosis[OR=11.397,95%CI(1.256,103.443)].conclusion:1.There was no significant difference in the incidence of perioperative complications and long-term efficacy between simple balloon dilation and stent implantation in the treatment of severe symptomatic midbrain artery stenosis.2.The postoperative residual stenosis rate was higher with balloon dilation alone,but the risk of postoperative restenosis was not significantly different from stenting.3.Mori typing may have an impact on the efficacy of intravascular therapy,and the higher the Mori typing,the worse the outcome.4.MoriB may have lower risk of recurrence of ischemic cerebrovascular events after stenting in mid-brain artery stenosis5.Multiple intracranial stenosis and diabetes mellitus may be risk factors for severe symptomatic intracranial intracranial stenosis after intravascular intervention. |
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