| Objective: To prospectively know the early effects of stenting of intracranial stenosis and analyze the incidence and nature of early ischemic lesions of symptomatic intracranial artery stenosis detected by DWI after stenting,especially approach the risk factors correlated to the ischemic lesions early after stenting of symptomatic intracranial artery stenosis,to provide reference for the clinical therapies.Methods: 29 consecutive patients admitted to Changhai hospital between Mar 2008 and Mar 2009, who were definited symptomatic intracranial artery stenosis by DSA and were treated by Gateway-WingSpan systems, were detected by DWI for new brain ischemic lesions before and after stenting. Record the basic clinical record(including age, sex, history of major cerebral ischemia, hypertension, diabetes, hyperlipidemia, smoking history, etc.), characteristics of target vessels(including the site of stenosis,Mori type, LMA type and stenosis at the proximal end of the target vascular),interventional procedures'characteristics of the patients(including the operator, the operation time, the amount of contrast, balloon size, the number of expanding, shift of the balloon when being expanded, stent size, whether or not to adjust the stent or micro-guide wire,vasospasm, the degree of stenosis before and after treatment), any new ischemic brain damage and its imaging features(including location, quantity and size).At the same time, DWI was performed in 27 consecutive patients definited intracranial artery stenosis by cerebral angiography before and after angiography. The same characteristics were recorded. At last, evaluate the effects of stenting,gain the incidence of the new DWI lesions after the tow interventive procedures, analyze the data of tow groups, to evaluate the safty of self-expanding stent-assisted angioplasty for the treatment of symptomatic intracranial atherosclerotic stenosis, explore the risk factors of the new brain ischemic lesions.Results:1. The perioperative efficacy of symptomatic intracranial atherosclerotic stenosis self-expanding stent angioplasty30 stenosis in 29 patients were treated by Gateway-WingSpan system.The the successful rate of treatment was 100%. The average degree of stenosis before stenting was 72.3±10.7%, the residual stenosis immediately after stenting was 29.5±13.9%. 2 patients(6.9%)had neurological dysfunction, 1 patient(3.4%) had cysthemorrhagia,1 patient(3.4%) had hemafecia, 1 patient(3.4%)had upper gastrointestinal bleeding, all of them were cured before discharged. In 30 days after stenting, no new neurological deficits happened. The overall adverse events rate was 17.2%(5/29patients), and neurological complications rate was 6.9%(2/29patients), no permanent neurological dysfunction, the perioperative fatality was 0.2. new brain ischemic lesions (1) Total 35.7% patients(20/56) were found new DWI ischemic lesions. Compared with the other 36 patients without new lesions,The type A in LMA typing(P=0.019), stenosis in proximal part of the target vessel(P=0.027) and time of the procedure had statistic difference.(2) 89 new DWI lesions were found in 20 of all patients(63 sites in 13 patients in stenting group and 26 sites in 7 patients in angiographic group).After procedure,2 patients in stenting group(13 and 24 new ischemic lesions) and one in angiographic group(12 new ischemic lesions) of the 20 patients were symptomatic. In stenting group, 11 patients(84.6%,11/13patients) were asymptomatic; In angiographic group, 6 patients(85.7%,6/7patients) were asymptomatic. The number of new lesions in each asymptomatic patients was 1-4.Whether patients with new DWI lesions had clinical symptom was correlated with the number of lesions(P=0.001,r=0.665) and the size of lesions(P<0.001,r=0.793).(3) In the treatment group 13 of 29 patients had 63 new brain ischemic lesions. 55 of them were in the region of target vascular, account for 87.3%. 2 of them were in the region supplied by the perforators which were covered by stents. the number(63sites) of all new lesions and that(55 sites) in the region of stented vascular were correlated(P<0.001,r=0.947),the new lesions number in the region supplied by the perforators which were covered by stents was not correlated with the total number of new DWI lesions(r=0.031,P=0.920); In angiographic group, the number(26 sites) of all new lesions and that(19 sites) in the region of stenotic vascular were correlated (P=0.022,r=0.827).(4) Smoking(P < 0.001) was the risk of new DWI lesions in angiographic group.Migration of balloon(P=0.02)was the high risk in stenting group.(5)The incidence rate of new DWI lesions in patients of stenting group was 44.8%. while the rate in angiographic group was 25.9%. Further analysis showed that there was significant deviation in Mori typing ( P < 0.001 ) , the location typing in LMA(P=0.001),vasospasm(P=0.012),time of procedure(P<0.001) and contrast medium(P<0.001) between tow groups.Conclusion: the treatment of symptomatic intracranial artery stenosis by WingSpan system was safe. DWI was valuable in safty assessment during angiography and stenting procedures. New DWI ischemic lesions may found in both procedures. Most of them were asymptomatic, but doctors should pay attention to them. The type A in LMA typing, stenosis in proximal part of the target vessel and time of the procedure were the risk in both procedures. Whether the patient with new DWI lesions had clinical symptom was correlated with the number and size of the lesions. Most of the new lesions in stented patient located in the region of stented vascular, and the migration of balloon in stenting is the high risk. To exactly know the risk of new DWI lesions need more patients and multiple centre study.
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