Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Intracranial Stent Implantation for Drug Resistant Atherosclerotic Stenosis: Results of 52 Cases

약물치료에 반응하지 않는 동맥경화성 뇌동맥 협착의 치료에 대한 스텐트 삽입술: 52예의 결과

  • Kim, Kuk-Seon (Department of Radiology, Hallym University Hangang Sacred Heart Hospital) ;
  • Hwang, Dae-Hyun (Department of Radiology, Hallym University Hangang Sacred Heart Hospital) ;
  • Ko, Young-Hwan (Department of Radiology, Hallym University Hangang Sacred Heart Hospital) ;
  • Kang, Ik-Won (Department of Radiology, Hallym University Hangang Sacred Heart Hospital) ;
  • Lee, Eil-Seong (Department of Radiology, Hallym University Hangang Sacred Heart Hospital) ;
  • Han, You-Mie (Department of Radiology, Hallym University Hangang Sacred Heart Hospital) ;
  • Kim, In-Soo (Department of Neurosurgery, Myungji St. Mari's Hospital) ;
  • Hur, Choon-Woong (Department of Neurosurgery, Myungji St. Mari's Hospital) ;
  • Min, Sun-Jung (Department of Radiology, Hallym University Hangang Sacred Heart Hospital)
  • 김국선 (한림대학교 의과대학 한강성심병원 영상의학과학교실) ;
  • 황대현 (한림대학교 의과대학 한강성심병원 영상의학과학교실) ;
  • 고영환 (한림대학교 의과대학 한강성심병원 영상의학과학교실) ;
  • 강익원 (한림대학교 의과대학 한강성심병원 영상의학과학교실) ;
  • 이일성 (한림대학교 의과대학 한강성심병원 영상의학과학교실) ;
  • 한유미 (한림대학교 의과대학 한강성심병원 영상의학과학교실) ;
  • 김인수 (명지성모병원 신경외과) ;
  • 허춘웅 (명지성모병원 신경외과) ;
  • 민선정 (한림대학교 의과대학 한강성심병원 영상의학과학교실)
  • Published : 2011.07.01
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Abstract

Purpose: We evaluated the usefulness of intracranial stent implantation for treatment of drug resistant atherosclerotic stenoses. Materials and Methods: Between March 2004 and July 2007, we tried intracranial stent implantation in 49 patients with 52 lesions (anterior circulation 48 cases, posterior circulation 4 cases) who had an ischemic stroke with more than 50% of major cerebral artery stenosis. We classified the lesions by their location and morphology, analyzed the results in terms of the success rate, complication rate, and restenosis rate during the follow-up period. Results: Intracranial stent implantation was performed successfully in 43 cases (82.7%). In eight of the nine cases, the stent implantation failure was due to the tortuosity of the target vessel. There was no major periprocedural complication. One patient showed cerebellar infarction after the procedure. Mean residual stenoses decreased from 70.2% to 13.0%. Four cases (9.3%) demonstrated in-stent restenoses and more than 50% during the mean and 25.3/month after the follow-up period. Conclusion: Success rate of intracranial stent implantation may improve on developing technique and more experience. Low rate of complication and restenosis suggest that we can consider intracranial stent implantation for treatment of drug resistant atherosclerotic stenoses.

목적: 약물치료에 반응하지 않는 동맥경화성 뇌동맥 협착이 있는 환자에서 스텐트 삽입술의 유용성을 알아보고자 하였다. 대상과 방법: 2004년 3월부터 2007년 7월까지 허혈성 뇌졸중의 증상이 있으면서 주요뇌동맥에 50% 이상의 협착이 있는 환자 중 적절한 와파린과 아스피린의 복용에도 증상이 호전되지 않거나 복용하기 어려운 49명의 환자에게서 총 52개의 스텐트 삽입을 시도하였다. 시술은 전뇌순환 48예, 후뇌순환 4예로 병변의 위치와 모양에 따라 분류를 하였으며, 시술 성공률, 시술 합병증 발생률 등을 분석하였고, 추적검사 기간의 재협착률을 조사하였다. 결과: 총 52예 중 43예 (82.7%)에서 스텐트 삽입에 성공하였고, 실패한 9예 중 8예에서 스텐트가 사행성 구조의 혈관을 극복하지 못하여 삽입에 실패하였다. 시술 도중 혈관의 천공, 파열 등의 주요 합병증은 없었고, 시술 후에 1예에서 소뇌에 경색이 발생하였다. 평균 70.2%의 시술 전 협착은 시술 후 평균 13.0%의 협착을 보였다. 평균 25.3개월의 추적 기간 4예 (9.3%)에서 50% 이상의 재협착이 발생하였고 모두 일시적 허혈성 뇌졸중의 증상을 보였다. 결론: 스텐트 삽입은 합병증 발생률과 재협착률이 낮아 안전하고 유용하여 약물치료에 반응하지 않는 뇌동맥의 동맥경화성 협착의 치료로 시도할 수 있을 것으로 생각하며 성공률은 기술의 발전과 경험의 축적으로 높일 수 있을 것으로 생각한다.

Keywords

References

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