Neuroform Atlas支架治疗症状性大脑中动脉粥样硬化性狭窄的多中心回顾性研究
该多中心回顾性研究纳入165例接受Neuroform Atlas支架置入的症状性大脑中动脉粥样硬化性狭窄患者，6个月随访时87.9%获得良好临床结局（mRS≤3）。术前狭窄率、病变长度、入院NIHSS评分及病变位于M1分叉部（远端三分之一）是不良预后的独立危险因素。
要点
- Neuroform Atlas支架治疗症状性大脑中动脉狭窄短期安全有效，6个月良好结局率87.9%。
- 病变位于M1分叉部（远端三分之一）是不良预后最强独立危险因素（OR 16.21）。
- 术前狭窄率、病变长度及入院NIHSS评分亦为不良预后独立危险因素。
诊断标准与关键数值
- 主要疗效终点为术后6个月良好临床结局，定义为mRS评分≤3；165例中145例（87.9%）达到良好结局，20例（12.1%）为不良结局。
- 多因素logistic回归显示不良预后的独立危险因素包括：术前狭窄率较高（OR 1.14，95%CI 1.03-1.26，p=0.01）、病变长度较长（OR 4.18，95%CI 1.32-12.26，p=0.01）、入院NIHSS评分较高（OR 1.27，95%CI 1.04-1.54，p=0.02）及病变位于M1分叉部（远端三分之一）（OR 16.21，95%CI 2.86-91.96，p=0.002）。
临床应用与阅片要点
- 阅片时需重点评估大脑中动脉狭窄率、病变长度及病变是否位于M1分叉部（远端三分之一），这些特征与支架术后不良预后相关。
- 报告应明确描述病变位置与分叉部的关系，M1远端三分之一病变提示预后风险显著增高。
局限性
- 本研究为回顾性设计，可能存在选择偏倚。
- 随访时间较短（至少6个月），缺乏长期疗效与支架内再狭窄数据。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND AND PURPOSE: This study aims to assess the safety and efficacy of the Neuroform Atlas stent in treating symptomatic MCA stenosis, hypothesizing that its advanced design may lead to more favorable outcomes in this high-risk patient population.
MATERIALS AND METHODS: Consecutive patients who underwent endovascular stenting for symptomatic intracranial atherosclerotic stenosis (ICAS) of the middle cerebral artery (MCA) from January 2020 to December 2025 were screened for inclusion. The Neuroform Atlas stent system was deployed in MCA. All patients were followed up for at least six months with vascular imaging (CTA or DSA). The primary efficacy endpoint was the rate of favorable clinical outcomes, defined as an mRS score ≤3, at six months post-procedure.
RESULTS: A total of 165 consecutive patients who underwent endovascular stenting for symptomatic MCA stenosis were included in this analysis. At the 6-month follow-up, 145 patients (87.9%) were classified as having a favorable clinical outcome, while 20 patients (12.1%) had an unfavorable outcome. The multivariate logistic regression analysis confirmed that a higher pre-procedural stenosis rate (OR: 1.14, 95% CI: 1.03-1.26, p = 0.01), greater lesion length (OR: 4.18, 95% CI: 1.32-12.26, p = 0.01), a higher admission NIHSS score (OR: 1.27, 95% CI: 1.04-1.54, p = 0.02), and most importantly, lesion location at the M1 bifurcation (distal third) (OR: 16.21, 95% CI: 2.86-91.96, p = 0.002) were independent risk factors for an unfavorable clinical prognosis.
CONCLUSION: The stenting of symptomatic MCA stenosis with the Neuroform Atlas stent system was associated with high technical success, a favorable short-term safety profile, and promising efficacy outcomes.
引用
- Liu M, Zhao Y, Hou X, et al. Neuroform Atlas Stent for middle cerebral artery Stenting of Symptomatic Intracranial Atherosclerotic Stenosis: A Multi-Center Retrospective Study. AJNR Am J Neuroradiol. 2026. PMID: 42140661. doi:10.3174/ajnr.A9417
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。