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Abstract：
Background and Purpose: Subgroup analysis of the SAMMPRIS trial showed a higher rate of periprocedural perforator strokes with the Wingspan stent in the basilar artery in patients with symptomatic intracranial atherosclerotic stenosis (ICAS). It remains unclear whether angioplasty (PTA) alone or in combination with other stent types (PTAS) will yield similar results in perforator-bearing segments of the anterior and posterior circulation. Methods: We retrospectively analyzed the periprocedural complication rate, long term outcome and stroke etiology in 59 consecutive patients with ICAS of the middle cerebral artery (79 treatments) and 67 patients with ICAS of the intracranial vertebral and basilar artery (76 treatments) treated with PTA or PTAS from 2007 to 2015 in a high-volume neuro-interventional center. Results: Periprocedural symptomatic ischemic strokes occurred significantly more often in patients with posterior vs. anterior ICAS treatment (14.5 vs. 5.1%, p = 0.048). During a mean follow-up period of 19 (±23.7) months, 5 recurrent ischemic and 2 hemorrhagic strokes (10.4%) occurred in the territory of the treated artery in posterior circulation compared to 2 ischemic strokes in the anterior circulation (3.4%, p = 0.549). Overall, significantly more patients treated for a posterior ICAS suffered a periprocedural or follow-up stroke [25% vs. 11.4%, p = 0.024]. Periprocedural ischemic strokes were predominantly perforator strokes (73.3%), while all ischemic strokes during follow-up were caused by distal embolization (57.1%) or delayed stent occlusion (42.9%). There was no difference between PTA alone and PTAS. Conclusion: The periprocedural and long-term symptomatic stroke rate was significantly higher in the treatment of perforator-bearing arteries in the posterior circulation. There was no difference between PTA alone or PTAS.
摘要：
背景和目的：SAMMPRIS试验的亚组分析显示，在症状性颅内动脉粥样硬化性狭窄（ICAS）患者中，基底动脉Wingspan支架的围手术期穿支卒中发生率更高。尚不清楚单独的血管成形术（PTA）或与其他支架类型（PTAS）联合使用是否会在前后循环的穿支带节段中产生类似的结果。方法:回顾性分析围手术期并发症发生率,2007年至2015年在高容量神经介入中心接受PTA或PTAS治疗的59例大脑中动脉ICAS患者(79例治疗)和67例颅内椎和基底动脉ICAS患者(76例治疗)的长期结局和卒中病因.结果：围手术期症状性缺血性卒中发生在后路患者中明显多于前ICAS治疗（14.5vs.5.1%,p=0.048)。平均随访19(±23.7)个月,5例复发性缺血性中风和2例出血性中风（10.4％）发生在后循环的治疗动脉区域，而2例前循环缺血性中风（3.4％，p=0.549)。总的来说,明显更多接受后路ICAS治疗的患者发生围手术期或随访期中风[25%vs.11.4%,p=0.024]。围手术期缺血性中风主要是穿支中风（73.3％），而随访期间所有缺血性卒中均由远端栓塞（57.1％）或延迟支架闭塞（42.9％）引起。单独PTA和PTAS之间没有差异。结论：治疗后循环穿支动脉的围手术期和长期症状性卒中发生率明显较高。单独PTA或PTAS之间没有差异。
