探讨多发颅内外血管狭窄的脑缺血患者中，由于责任血管闭塞、狭窄段较长、全程纤细等原因无法针对责任血管进行手术治疗而行狭窄的非责任血管支架血管成形术的有效性、可行性及安全性。

回顾性收集首都医科大学宣武医院神经外科2006年6月至2010年8月期间收治的多发颅内外血管狭窄患者中，通过对狭窄的非责任血管支架术治疗的有脑缺血症状的患者75例，有效随访(2年以上)64例。所有64例患者依据术前症状并以美国国立卫生研究院卒中量表(NIHSS)评分是否为0分为两组：TIA组(术前NIHSS=0)37例；脑梗死组(术前NIHSS≠0)27例。对TIA组患者依据手术前后症状缓解情况进行总体评分量表(GES)打分；对脑梗死组病例分别行术前、术后NIHSS评分。比较两组患者术前术后症状缓解情况。

TIA组37例患者有28例完全治愈，治愈率达75.68%；8例术后TIA发作次数减少，好转率21.62%；1例术后症状同术前无明显变化，占2.7%；脑梗死组27例患者术后神经功能障碍程度明显减轻(P<0.05)。两组患者均没有术后加重者及死亡者。TIA组症状缓解率较高，脑梗死组神经功能障碍程度减轻明显，手术前后症状差异有统计学意义。

颅内外各血管之间解剖结构上存在着广泛的吻合，理论上可经吻合支代偿而增加缺血区脑组织的血流量。临床研究证明狭窄的非责任血管支架术后，责任病灶区脑缺血症状确实能够得到有效改善，而且手术相对安全。所以针对责任血管难以进行手术治疗的多发颅内外血管狭窄的脑缺血病人，可以采用这种治疗方法，行狭窄的非责任血管支架术通过吻合支代偿责任病灶区血供，达到改善脑缺血症状的目的。

A retrospective study of interventional therapy of non-responsibility vessels in multiple extracranial and intracranial vascular stenosis in Xuanwu Hospital,investigate the efficacy, safety and feasibility of the methods.

During 2006 to 2010, the patients with multiple extracranial and intracranial vascular stenosis, treated with interventional therapy of non-responsibility vessels, were admitted in Xuanwu Hospital, Capital Medical University. Sixty-four patients were followed up (more than 1 year). Analyze the improvement of preoperative and postoperative ischemic symptom. To the patients with the neurological deficits, we do the NIHSS score. To the patients without the neurological deficits, we do the GES score. The method was as follows. (1)Depending on whether there were the neurological deficits, the patients were cultured into 2 groups to compare the data of preoperative and postoperation. (2)Depending on the relationship between responsibility vessels and non-responsibility vessels, the patients were cultured into 3 groups, anterior-posterior-circulation group, right and left internal carotid artery group, external and internal carotid artery groups. And then in the each group, the patients were grouped into 3 subgroups according to the degree of neurological deficits. (3)Compare the disparity of therapeutic effect between anterior--posterior-circulation and right and left internal carotid artery groups.

Among 64 cases of this group, 1 patient with R-ICA obstruction and R-ECA severe stenosis after the interventional therapy,whose swirl disappeared and vision of the right eye recovered apartly.In the other 63 cases, 21 patients with neurological deficits, 36 patients with no neurological deficits but only with TIA, the clinical effect is significant (P=0.000).In 42 patients of the anterior-circulation and posterior-circulation group (25 patients with NIHSS score=0, 17 patients with NIHSS score≠0),the effect is also significant(P=0.000). In 21 patients of right and left internal carotid artery group(11 patients with NIHSS score=0, 10 patients with NIHSS score≠0), the clinical symptom is recovered significantly (P<0.01) . Follow up data showed clinical stabilization in 1 of vertebral artery post-stenting. All the patients with the neurological deficits were recovered partly, without TIA. There were no complications.

Theoretically,there are many transcranial anastomoses between extracranial and intracranial vascular, and the ischemia could be compensated by vessels anastomoses. Clinical studies have shown that non-responsible vessels stenting can indeedly improve the symptoms.The non-responsible vessels stenting is a relative safe and effective method. There is no obvious difference between the compensate effect of anterior communicating artery and posterior communicating artery as vessels anastomoses. Therefore, to the patients with multiple extracranial and intracranial vascular stenosis not to do interventional therapy of responsibility vessels, we can do interventional therapy of non-responsibility vessels to compensate the blood supply of the culprit lesion through vessels anastomoses, to improve the symptom.