The Clinical Analysis Of The Endovascular Stents For Symptomatic Intracranial Artery Stenosis

PartⅠThe Study of Clinical Assays for Patients withSymptomatic Intracranial Artery StenosisObjective: To compare with the difference between the patients with intracranial arterystenoses and the patients with extracranial artery stenoses.Methods: 124 inpatients with cerebral-arterial stenoses that have been treated inChanghai hospital from Jan. 2001 to Jan. 2006 are enrolled in this study. The assaysinclude serum lipid (total serum cholesterol & LDL), CRP, ESR, Uric Acid and RF. 68patiens have intracranial artery stenoses. Two groups patients are compared with all ofabove factors. We try to find out some special factors which can be used to indentifythe patients with intracranial artery stenosis.Results: After comparison of all factors, there were no significantly different betweentwo group patients. The mean volume of CRP of intracranial stenosis patients washigher than that of extracranial stenosis patients(8.31±2.16 mmol/L vs. 7.57±1.99mmol/L), but there was no statistical significance (P=0.8085), the same as TC.ESR of intracranial stenosis was lower than that of extracranial stenosis, and also therewas no statistical significance (P＞0.05). CRP of 79.84% patients is superior to 3.0mg/L,and it means CRP is a dangerous factor. CRP was higher in cerebral arterial stenosispatients. There was no significant difference between two groups of the rate of theabnormality in clinical assays. The average age of intracranial stenosis patients isyounger than that of extracranial stenosis patients, but there is no statisticalsignificance.Conclusion: CRP was elvated in patients with cerebral arterial stenoses patients. PartⅡClinical Analysis of stenting for Symptomatic IntracranialStenosis and Comparison Between Stenting and MedicalTreatment(WASID)Objective: To assess the safety and clinical efficacy(short-term, mid-term, long-term)of stenting for patients with symptomatic stenosis of intra-cerebral arteries, and tocompare with the best medical treatment in order to assess the efficacy of stenting forsymptomatic intracranial artery stenosis.Method: From 1.2001-1.2006 202 patients (204 stenoses)were treated by Stent-assistedAngioplasty (SAA) in Changhai hospital. The information of all in-patients includes:MRI, MRA, DSA et al, and the records of operational procedurce and the follow-upinformation. First all patients compared degree of stenosis before operation with afteroperation, and Wingspan Study. To compare NIHSS and mRS of pre-operation with ofpost-operation, 30d after operation, and the longest follow-up time, we find out theefficacy of SAA. To analysis DSA for pre-operation and post-operation, we find thedifference of the arterial diameter at two different times. Binary angiographic restenosiswas defined as diameter stenosis＞50% in the in-segment area (including the stent areaand 5-mm segments proximal and distal to the stent edges). To analysis the location,morphology, diameter of the criminal artery, degree of stenosis, length of stenosis,having or not having plaque et al, we discuss the angioplastic classifications andmechanism of perforator stroke.Result: The average degrees of stenosis of pre-operation and post-operation were77.64±8.75% and 11.55±10.44%(P＜0.05). 14 patients had major stroke, and one diedfrom rupture of MCA in 30 days. In WASID, 12 patients in aspirin group (4.3%) and 28patients in Warfarin group (9.7%) died. Rates of death and stroke in SAA group werelower than in WASID (P＜0.05). The degree of stenosis post operation is lower thanWingspan study. 22 patients occurred restenosis in SAA group. Follow up, the rate ofrestenosis in drug eluting stents group is lower than that in naked stents group. Theysequentially received medical therapies. 4 patient occured perforator stroke (PS). Theyaccepted medical therapies, and the symptoms were improved.Conclusion: SAA is an efficient technique for treating symptomatic intracranial arterystenosis and preventing ischemic stroke. Death and stroke rates were lower ofperioperative time. Long-term follow-up showed the recurrent stoke were lower. Theroles of SAA are expanding diameter, stabilization of plaque and changinghemodynamics. The rate of restenosis of drug eluting stents is lower. PartⅢAnalysis the Causes of More than 50% of Residual StenosisAfter Percutaneous Transluminal Angioplasty (PTA) of IntracranialStenosisObjective: To analysis the causes of more than 50% of residual stenosis afterPercutaneous Transluminal Angioplasty (PTA) of intracranial stenosis.Method: From Jan. 2000-Jan. 2006 9 patients were treated by PTA. The procedureswere difficult, and postoperative stenososes of all patients were still more than 50%.One patient had stenosis at MCA and an aneurysm at the ipsilateral. Three patients hadsingle stenosis, and five multiple stenoses. Among these patients, we have done stentingsuccessfully for three. The stents could not cross the tortuous arteries in two patients,then we just did Percutaneous Transluminal Cerebral Balloon Angioplasty (PTCBA).Four patients were treated only by PTCBA.Result: At a moment's notice, the diameters of the vasculars were dialated a little, andall postoperative stenoses were more than 50%. The blood flow had a little progress.Conclusion: The characteristics of intracranial stenosis are different from peripheralvascular stenosis. Much more flexibility and feasibility stents need to be used in thiskind of operation. Right now some cases have been showed worse result. So new stentsand other equipments should be invented in the future days, and we also need makesome more precise standards for PTA and SAA.