卒中研究进展：介入放射学进展（二）
AdvancesinStroke:AdvancesinInterventionalRadiology颅内和颅外脑动脉粥样硬化支架成形术
IntracranialandExtracranialStentingforAtherostenoticDisease
最近和最终发表的关于支架成形术与积极内科处理用于预防颅内动脉狭窄患者复发性卒中(StentingandAggressiveMedicalManagementforPreventingRecurrentStrokeinIntracranialStenosis，SAMMPRIS)的报告对两种治疗的远期疗效进行了分析。37研究者的结论是，对高危的颅内动脉高度狭窄相关性近期卒中患者，积极内科处理比使用Wingspan系统有益处，而且这一益处会持续3年。作者还讨论了唯一可能潜在地从支架成形术中获益的亚组，这个亚组包括在积极内科处理下仍有≧2次卒中发作且最近一次卒中发生在＞7天之前的、狭窄程度达70%-99%的患者。经选择过的有与低灌注有关的症状（如，椎基底动脉供血不足）的患者也可能看到支架成形术的益处。
ThemostrecentandfinalpublicationonStentingandAggressiveMedicalManagementforPreventingRecurrentStrokeinIntracranialStenosis(SAMMPRIS)analyzesthelong-termbenefitofboththerapies.Theinvestigatorscon-cludedthatforhigh-riskpatientswithrecentstrokeasso-ciatedwithahigh-gradeintracranialstenosis,aggressivemedicalmanagementisbeneficialoverstentingusingtheWingspansystem,andthebenefitpersistsfor3years.Theauthorsalsodiscussthattheonlysubgroupthatmaypoten-tiallybenefitfromstentingincludepatientswith70%to99%stenosiswhopresentwith≥2strokesdespiteaggressivemedicalmanagement,andwhoselaststrokeoccurred7daysago.Selectedpatientswithsymptomsrelatedtohypo-perfusion(eg,vertebrobasilarinsufficiency)mayalsoseeabenefitfromstenting.
过去的多项关于颈动脉支架成形术（carotidarterystenting，CAS）的随机临床试验，包括欧洲症状性严重颈动脉狭窄患者内膜剥脱术与血管成形术对比研究（EuropeanstudiesEndarterectomyVersusAngioplastyinPatientsWithSymptomaticSevereCarotidStenosis，EVA-3S）、支架保护下的血管成形术与颈动脉内膜剥脱术（Stent-ProtectedAngioplastyVersusCarotidEndarterectomy，SPACE）、国际颈动脉支架成形术研究（InternationalCarotidStentingStudy，ICSS）和颈动脉血管重建内膜剥脱术与支架成形术试验（CarotidRevascularizationEndarterectomyVersusStentingTrial，CREST），都没有能够显示支架成形术优于颈动脉手术。最近发表的一项对日本在10年间行颈动脉支架置入术的例患者的回顾性调查报告了可接受的较低30天内并发症和死亡率。随远端保护方法的不同，30天时的主要不良事件（卒中、心肌梗死或死亡）的发生率从3.5%到10.2%之间。这组数据是极好的，可与CEA相媲美。
Multiplepastrandomizedclinicaltrialsoncarotidarterystenting(CAS),includingtheEuropeanstudiesEndarterectomyVersusAngioplastyinPatientsWithSymptomaticSevereCarotidStenosis(EVA-3S),Stent-ProtectedAngioplastyVersusCarotidEndarterectomy(SPACE),InternationalCarotidStentingStudy(ICSS),andtheCarotidRevascularizationEndarterectomyVersusStentingTrial(CREST),couldnotshowasuperiorityofstentingovercarotidarterysurgery.Arecentlypublishedretrospectivesurveyofcarotidarterystent-ingperformedinpatientsinJapanduringaperiodof10yearsreportsacceptablelowincidenceof30-daymorbidityandmortality.38Therateofmajoradverseevents(stroke,myo-cardialinfarction,ordeath)at30dayswasvariedfrom3.5%to10.2%dependingonthedistalprotectionmethod.Thedataareexcellentand北京白癜风治疗最好的医院是哪家白班
