Neuroform3支架在急诊血管内栓塞破裂性颅内宽颈动脉瘤中的应用

Application of Neuroform3 stent in endovascular embolization of intracranial acutely ruptured widenecked aneurysms

目的评价急诊血管内Neuroform3支架辅助下可解脱弹簧圈栓塞破裂的颅内宽颈动脉瘤的疗效和中期随访。方法回顾性分析最近18个月急诊介入栓塞治疗的破裂出血性颅内动脉瘤48例,其中26例在72h内实施Neuroform3支架辅助下弹簧圈栓塞术。其中3例动脉瘤位于大脑前动脉A1段,3例位于大脑中动脉M1和M2段,13例位于后交通,2例位于颈内动脉眼动脉段,2例位于基底动脉顶端,2例位于椎动脉V2和V4段,1例位于小脑后下动脉;3例在第1枚弹簧圈释放后植入支架,1例在第2枚弹簧圈释放后植入支架,2例在第4枚弹簧圈释放后植入支架,10例在第1枚弹簧圈无法在瘤腔内成篮后植入支架,其余10例先植入支架再进行弹簧圈栓塞,所有微导管均通过支架网眼进入动脉瘤。结果所有病例均成功释放支架(100%),覆盖了瘤颈,同期行弹簧圈填塞动脉瘤。术后即刻造影显示动脉瘤完全栓塞23例(88.5%),次全栓塞3例(11.5%);术中1例支架轻度回撤,无血栓事件和动脉瘤再破裂出血发生,所有患者均恢复良好出院。栓塞术后随访到23例,至少复查1次脑血管造影,最多复查3次;完全致密栓塞14例(60.8%)动脉瘤均未显影,6例瘤颈少许显影病例中3例(11.5%)存在血栓形成,次全栓塞1例(3.3%)瘤体再通,另外2例始终稳定,所有病例载瘤动脉通畅,狭窄2例(7.7%),临床上无任何症状,术后所有患者均无再出血。结论急症血管内应用Neuroform3支架辅助弹簧圈栓塞破裂出血的颅内宽颈动脉瘤是方便的、安全的和有效的。

Objective To evaluate the effect of endovascular Neuroform3 stent-assisted detachable coil embolization with and to make a mid-term follow-up observation. Methods The clinical results of emergent interventional embolization in 48 patients with intracranial acutely-ruptured wide-necked aneurysms, encountered in the past 18 months, were retrospectively analyzed, of which Neuroform3 stent-assisted detachable coil embolization was performed in 26 cases within 72 hours after the onset of the disease. The aneurysms located at the A1 segment of anterior cerebral artery (n = 3), the M1 and M2 segment of middle cerebral artery (n = 3), the posterior communicating artery (n = 13), the ophthalmic segment of internal carotid artery (n = 2), the top of basilar artery (n = 2), the V3 and V4 segment of vertebral artery (n = 2), or the posterior inferior cerebellar artery (n = 1). The stent was implanted after the first (n = 3), second (n = 1) or fourth (n = 2) coil was delivered. In 10 cases the first coil could not be formed in basket shape within the aneurysm sac. In the remaining 10 cases the stent implantation procedure was carried out before the coil embolization, and the microcatheter was successfully introduced into the aneurysm through the struts of the stent in all ten cases. Results Successful deployment of the Neuroform3 stent was obtained in all cases(100%), with the coil covering the neck of the aneurysm. The coils were positioned for all aneurysms in single session. Immediate angiography after the procedure showed that total occlusion was achieved in 23aneurysms (88.5%) and subtotal occlusion in 3 aneurysms (11.5%). During the whole procedure, the stent moved slightly in one case, no obvious thromboembolic or rebleeding event occurred. All patients showed a good recovery at the time of discharge. Follow-up could be conducted in 23 cases for a period over 18 months, cerebral angiography for check-up was made in 1 ～ 3 times. Complete occulusion was observed in 14 cases (60.8%). Of 6 cases whose aneurysm neck showed a little residual opacification, progressive thrombosis occurred in 3(11.5%). Of 3 cases with subtotal occulusion, stable condition was seen in 2 cases and recanalized aneurysm in one case. Delayed in-stent stenosis was observed in 2 cases (7.7%). Conclusion Neuroform3 stent-assisted detachable coil embolization is a simple, safe and effective method for the treatment of intracranial acutely-ruptured wide-necked aneurysms.