单纯血管内支架植入术治疗颅内动脉瘤

Simple endovascular stent implantation for the treatment of intracranial aneurysm

目的探讨单纯血管内支架植入术治疗颅内动脉瘤的效果、安全性以及可行性。方法对单纯施行血管内支架植入术治疗的31例颅内动脉瘤患者(囊状动脉瘤19例,梭形动脉瘤6例,夹层动脉瘤6例)的临床资料进行回顾性分析。其中真性动脉瘤30例,Hunt-Hess分级Ⅰ级27例,Ⅱ级2例,Ⅲ级1例;假性动脉瘤1例。结果30例(96.77%)单纯行血管内支架植入术治疗的患者均获得成功,其中2例采用Jostent覆膜支架,动脉瘤瘤腔完全不显影;6例夹层动脉瘤者4例夹层完全闭塞,2例夹层明显缩小;2例囊状动脉瘤及1例假性动脉瘤瘤腔内对比剂充盈明显减少。手术后随访3～72个月,患者均恢复良好,无再出血或脑缺血事件发生。手术后3个月脑血管造影检查血流通畅,动脉瘤闭塞或体积缩小,支架内无明显狭窄;无一例死亡或发生永久性并发症。结论对于栓塞或手术夹闭困难的颅内动脉瘤,单纯应用血管内支架植入术治疗安全、有效及可行。覆膜支架可直接闭塞动脉瘤,金属裸支架亦可达到闭塞动脉瘤或降低动脉瘤瘤腔内压力的效果。

Objective To explore the efficacy, safety and feasibility of simple endovascular stent implantation for the treatment of intraeranial aneurysm. Methods The clinical data of 31 patients with intracranial aneurysm （19 with sacculated aneurysm, 6 with fusiform aneurysm, 6 with dissecting aneurysm） treated with simple endovaseular stent implantation were retrospectively analysed. Among them, there were 30 cases with true aneurysm （Hunt-Hess grade Ⅰ, 27 cases; grade Ⅱ, 2 cases; grade Ⅲ, one case）, and one case with false aneurysm. Results Among 31 cases, 30 cases （96.77%） were treated with simple endovaseular stent implantation. Two of them after treating with stent-graft （Jostent） the aneurysm cavity was not developed. In 6 eases with dissecting aneurysm, the dissection was completely obliterated in 4 cases, and obviously reduced in 2 cases. In 2 cases with saceulated aneurysm and one with false aneurysm, the contrast-medium filling in the aneurysm cavity was apparently decreased. During 3-72 months follow-up period, all the patients recovered. No hemorrhage recurrence or cerebral isebemie events occurred. Patients were reexamined at 3 months after operation. Blood flow was unobstructed. Aneurysms were obliterated or aneurysm size was reduced. No obvious stenosis was found at all the stents. No death and permanent complication occurred. Conclusion Simple endovaseular stent implantation is a safety, effective and feasible method for intracranial aneurysm patients who are not suitable to treat with endovascular embolization by coilling or clipping. Stentgraft can directly obliterate the aneurysm. Bare metal stent （BMS） can also achieve the same result or lower the aneurysm cavity pressure.