The Study Of Interventional Therapy For Symptomatic Intracranial Atherosclerotic Stenosis

Objective:To investigate the effectiveness and safety of the treatment of symptomatic intracranial atherosclerotic stenosis with intracranial artery stenting,and explore the influencing factors.Methods: 112 patients with symptomatic intracranial atherosclerotic stenosis treated with intracranial artery stenting were enrolled in this study from January 2016 to January2017.All patients included in the study were recorded and followed up(including mRS score,NIHSS score and imaging features).To analyze the efficacy of the treatment of symptomatic intracranial atherosclerotic stenosis with intracranial artery stenting.To study the relationships among the location of intracranial artery stents implantation(including intracranial segment of carotid artery,M1 segment of middle cerebral artery,V4 segment of vertebral artery,and segment of basilar artery),the type of stents(including balloon-expandable stents and self-expandable stents)and the end point events.And to find out the causes of complications associated with intracranial artery stents implantation.The primary endpoints were defined as the occurrence of stroke in the target vessel basin(including hemorrhagic stroke and ischemic stroke)or death within 30 days of operation,and the occurrence of disability stroke in the target vessel during the follow-up period(mRS score ? 2 points or the increase of NIHSS score ? 3 points)and stent related death.The secondary endpoints was restenosis in stents confirmed by DSA or CTA with ? 50% restenosis(including symptomatic restenosis and asymptomatic restenosis).Results:(1)111 patients were successfully implanted with 111 intracranial artery stents(among them there were 74 balloon-expandable stents and 37 self-expandable stents).Only one patient terminated the operation because of intracerebral hemorrhage without stent implantation.The total success rate was 99.1%.(2)The improvement of intracranial artery stenosis was 77.06% ±7.71 in balloon-expandable stent group(p=0.000<0.05),compared of 71.35% ±6.63 in self-expandable stent group(p=0.000<0.05).The difference is statistically significant.(3)The major endpoint events occurred in 8 of 112 patients,in which 5 patients in balloon-expandable stentgroup and 3 patients in self-expandable stent group,p=1.000 > 0.05.The secondary endpoint events occurred in 10 patients,in which 5 patients in balloon-expandable stent group and 5 patients in self-expandable stent group,p=0.294>0.05.(4)The incidence of endpoints varied in different stenting sites.Among them the incidence of endpoint events in basilar artery segment was the highest.However,there was no significant difference among the groups,p=0.773>0.05.(5)Further analysis of the end point events in the basilar artery segment showed that 6 of 7 cases were in balloon-expandable stent group,and only one was in self-expandable stent group,p=0.03<0.05,which was statistically significant.Conclusion: The perioperative and follow-up results of symptomatic intracranial atherosclerotic stenosis with intracranial artery stenting treatment showed good effectiveness and safety.The incidence of complications in the treatment of intracranial artery stenting in basilar artery segment was higher than other sites.However,due to the insufficient of the sample size and the follow-up time,there was no statistical difference.So further research is needed.Self-expandable stent was safer than balloon-expandable stent in the treatment of basilar artery stenosis.