頭蓋内動脈硬化性狭窄に対するＰＴＡ／ｓｔｅｎｔｉｎｇの臨床成績と問題点

Abstract

Recently, PTA/stenting for intracranial atherosclerotic stenoses has been reported as a treatment option. We describe clinical results of PTA/stenting for 87 patients of intracranial atherosclerotic stenoses (88 lesions). The procedure was performed under local anesthesia via percutaneous transfemoral route. In 61 patients, we performed PTA only and used stent in 26 patients. In 87 patients, technical success rate was 97% and the mean stenosis rate before PTA/stenting, 77.0%, decreased to 25.4% after the procedure. In particular, 26 cases of stenting showed remarkable improvement of the mean stenotic rate (77.7% to 5.5%). The morbidity, neurological deficits at 30 days and mortality rate was 10.3%, 6.9% and 2.3%, respectively. The ischemic complications such as cerebral embolism, dissection, and stent thrombosis occurred, while there were hemorrhagic complications such as intracranial bleeding due to hyperperfusion, rupture of associated intracranial aneurysm and cerebellar hemorrhage caused by bleeding tendency. In addition, the restenosis after stenting tends to occur less than that PTA only.Because of the high morbidity and mortality rate compared with the procedure for extracranial lesions, PTA/stenting for intracranial arterial stenoses may require stricter indications and the prevention from predictable complications of this procedure. Long-term follow up and study of the natural history of the intracranial atherosclerotic stenoses seem to be important to establish this treatment.