Neuroform和弹簧圈治疗梭形及宽颈颅内动脉瘤

Endovascular treatment of fusiform and wide-necked intracranial aneurysms with the Neuroform stent and detachable coils

目的报告应用Neuroform支架治疗颅内宽颈和梭形动脉瘤的治疗结果。方法15例病人17个梭形及宽颈颅内动脉瘤，分别位于颈内动脉8个，椎动脉5个，基底动脉顶端1个，大脑中动脉1个，大脑后动脉1个，小脑后下动脉1个。所有的病例，球囊再塑形技术术前均认为存在困难，均使用支架结合弹簧圈栓塞。动脉瘤直径在4～30mm之间。结果所有病例支架均成功释放，均是先释放支架，再填弹簧圈。完全栓塞及次全栓塞（〉95％）的有6例，部分栓塞的有9例。无围手术期脑卒中及死亡，10例病人获得随访，病人神经状况均良好，平均随访时间是（6．2±3．2）个月。结论使用Neuroform支架治疗首发及复发的梭形及宽颈颅内动脉瘤是安全，有效的。未发现与释放支架相关的长期神经系统并发症。大部分病例在短期随访中载瘤动脉瘤通畅，栓塞部位稳定。

Objective To evaluate the use of this steut for treatment of fusiform and broad-necked intracranial aneurysms. Method Seventeen fusiform and broad-necked intracranial aneurysms in 15 patients were treated electively. They were located at the internal carotid artery （ 8 ）, vertebral artery （ 5 ）, hasilar tip（ 1 ）, middle cerebral artery （ 1 ）, posterior cerebellar artery （ 1 ） and posterior inferior cerebellar artery （1）. In all cases, previous attempts with the remodeling technique were technically judged difficult and combined stent placement across the aneurysm neck and subsequent coiling of the sac. Aneurysms diameter size varied from 4 to 30 mm. Results A total of 16 aneurysms in 15 patients were treated with this procedure. In no cases, stent deployment failed. All aneurysms were initially stented, followed by coil placement. Complere or subtotal （ 〉 95% ） occlusion was achieved in 6 patients, and partial occlusion （ 〈 95% ） was achieved in 9 patients. The periprocedural rate of any stroke or death was 0%. Angiographic follow-up was obtained in 10 patients. Neurological status remained well in all patients at a mean clinical follow-up of （6. 2 ± 3.2 ） months. Conclusions Primary and recurrence treatment of fusiform and widenecked intracranial aneurysms using the Neuroform stent is feasible and effective. No permanent neurological deficits were associated with stent deployment. Short-term follow-up identified intact parent arteries and stable occlusion rates in the majority of cases.