颅内自膨胀支架结合弹簧圈治疗脑动脉瘤

Treatment of intracranial aneurysms with self-expanding stent and coils

目的 报道采用自膨胀颅内专用支架 (Neuroform支架 )结合弹簧圈栓塞治疗颅内宽颈动脉瘤 ,初步探讨该支架的特点、短期疗效及应用前景。方法 采用Neuroform支架结合弹簧圈栓塞治疗 32例 34枚颅内宽颈动脉瘤。颈内动脉海绵窦段 3例 ,眼动脉 3例 ,后交通动脉 8例 ,前交通动脉 3例 ,大脑中动脉分叉部 5例 ,椎动脉 6例 ,基底动脉顶端 1例 ,基底动脉干 2例 ,大脑前动脉A3段 1例 ,多发动脉瘤 2例。通过Renegade微导管释放Neuroform支架覆盖动脉瘤瘤颈 ,预先将另一微导管置入动脉瘤腔或将微导管通过支架网孔以弹簧圈栓塞动脉瘤。结果 31例 34个支架成功到位释放 ,1例基底动脉顶端动脉瘤因支架无法通过狭窄的大脑后动脉而改用BX支架。 3例 1次各置入 2枚支架。 2 4例致密栓塞 ,6例瘤颈残留 ,2例部分栓塞。 1例术中发生支架内血栓 ,死亡 1例 ,其余患者均恢复良好出院。临床随访 30例 ,随访期 1～ 6个月 ,平均 4 .7个月 ,无再出血及血栓栓塞症状发生。 1 1例术后 3个月血管造影随访 :7例致密栓塞的动脉瘤均未显影 ;4例瘤颈残留者 ,2例无变化 ;2例原有瘤颈残留未再显影。结论 Neuroform支架技术上容易操控 ,顺应性好 ,安全性高 ,可以到达颅内较远端的血管 ,大大扩展了支架技术治疗颅内血管病变的应用范围 。

Objective To evaluate the preliminary experience of the combined application of a self expanding neurovascular stent system (Neuroform stent) and detachable coils in the management of wide necked intracranial aneurysms. Methods Self expanding neurovascular stents and coils were used in the treatment of 32 patients. There were total 34 intracranial wide necked aneurysms in 32 cases including cavernous segment ICA aneurysms in 3, ophthalmic artery aneurysms in 3, PComA in 8, AcomA in 3, MCA bifurcation in 5, vertebral artery in 6, basilar tip in 1, basilar trunk in 2 and distal anterior cerebral artery aneurysm in 1. The Neuroform stents were deployed across the neck of aneurysm. Another microcatheter was introduced into the aneurysm sac in advance or through stent mesh and then detachable coils were released to embolize the aneurysms. Results Thirty four Neuroform stents were successfully deployed in 31 patients .Balloon inflation stent was used for 1 patient with basilar tip aneurysm after failure of getting the Neuroform stent through the stenotic PC. Total occlusion was achieved in 24 patients, residual neck in 6 patients and partial occlusion in 2 patients. In stent thrombosis occurred in 1 patient. Thirty one patients recovered well but with one death. Thirty patients were under clinical followed up from 1 to 6 months with an average of 4.7 months.There was no bleeding or thromboembolic events. Eleven patients were angiographically followed up for 3 months after the procedure, Among them, no filling was shown for the 7 aneurysms which were densely packed. Other 4 aneurysms with neck remnant including 2 stable and another 2 with disppeared neck. Conclusions The Neuroform stent with high flexibility is technically feasible and can be safely navigated into even distal small neurovasculature.The long term effect still need to be further investigated.