Zhongguo cuzhong zazhi (Oct 2019)
支架置入与球囊扩张治疗特发性颅内高压伴静脉窦狭窄的疗效比较 Stenting Versus Balloon Angioplasty in Idiopathic Intracranial Hypertension Patients with Venous Sinus Stenosis
Abstract
目的 本研究旨在比较支架置入与球囊扩张治疗特发性颅内高压（idiopathic intracranial hypertension， IIH）伴静脉窦狭窄的疗效差异。 方法 对2012年1月-2015年12月在首都医科大学附属北京天坛医院接受介入治疗（支架置入或球囊 扩张）的IIH伴静脉窦狭窄患者的基线特征、手术过程、围手术期管理和临床结局进行了前瞻性连续 性登记。介入治疗方案由神经介入医师和患者协商决定。临床结局改善程度分为3级：症状消失、症 状改善、症状无变化或加重。通过比较支架组和球囊扩张组术后3个月、6个月、12个月症状消失的比 例，探讨两种治疗方法的疗效差异。 结果 本研究共纳入45例患者，其中支架组26例，球囊扩张组19例。两组患者的基线人口学 特征差异无统计学意义。支架组术后颅内静脉窦狭窄两端的压力差显著低于球囊扩张组（中位 数：0 vs 7 mm Hg，P <0.001）。与球囊扩张相比，接受支架置入治疗的患者术后3个月（57.7% vs 0， P <0.001）、6个月（88.5% vs 5.9%，P <0.001）和12个月（88.5% vs 23.5%，P =0.001）症状消失的比例 更高，提示临床预后更好。 结论 支架置入治疗IIH伴静脉窦狭窄的效果优于球囊扩张，但该结论还需要未来开展多中心随机 对照试验来进一步证实。 Abstract: Objective To compare the clinical outcome of patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis (VSS) treated by stenting and balloon angioplasty. Methods The baseline characteristics, operative procedure, perioperative management and clinical outcome of consecutive IIH and VSS patients who underwent stenting and balloon angioplasty in Beijing Tian Tan Hospital, Capital Medical University were prospectively recorded from January 2012 to December 2015. The treatment strategy was decided by consultation between interventional neurologists and patients’ authorized representatives. According to the different treatment options, the eligible patients were divided into stent group and balloon group. The clinical outcome was defined as symptoms unchanged, symptoms improve or symptoms disappear. The proportion of patients with symptoms disappearing at post-procedure 3, 6 and 12 months between both groups was compared. Results A total of 45 patients were finally enrolled in this study, with 26 cases were in the stent group and 19 cases in the balloon group. The baseline characteristics of both groups had no statistical difference. The intracranial venous sinus trans-stenosis pressure difference in stenting group was lower than that in balloon group (0 vs 7 mm Hg, P <0.001). The patients treated with stenting exhibited a higher proportion of asymptomatic conditions at 3 months (57.7% vs 0, P <0.001), 6 months (88.5% vs 5.9%, P <0.001) and 12 months (88.5% vs 23.5%, P =0.001) than those treated with balloon angioplasty. Conclusions Compared with balloon angioplasty, stenting showed a better efficacy for IIH and VSS patients. Future randomized controlled multicenter trials are required to confirm our findings.
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