Neuroform颅内支架辅助栓塞宽颈颅内动脉瘤的初步经验

Neuroform intracranial stent for embolization wide-necked cerebral aneurysm: preliminary experience.

目的 报道我科使用Neuroform支架辅助可脱式弹簧圈栓塞宽颈脑动脉瘤的初步经验。方法 2 2例 2 4枚宽颈颅内动脉瘤采用Neuroform支架和弹簧圈进行栓塞 ,其中急性破裂动脉瘤 19枚、未破裂动脉瘤 5枚。结果 支架均成功地释放 ,支架置入后的造影未发现有瘤内造影剂滞留的血流动力学改变。 10 0 %闭塞动脉瘤 18枚 ,90 %以上闭塞 5枚 ,1枚伴发的未破裂小型宽颈动脉瘤在支架置入后微导管无法超选 ,载瘤动脉均通畅。有 2枚动脉瘤虽有支架阻挡 ,但仍有部分弹簧圈畔进入载瘤动脉。所有患者没有出现与支架置入有关的症状性缺血性并发症。 17例造影随访中 ,有 1例在 3个月复查时发现再通 ,进行 2次栓塞完全闭塞动脉瘤 ,其余未见复发 ,结论 Neuroform颅内支架使用安全有效 ,适合于宽颈颅内动脉瘤的支架辅助弹簧圈栓塞 ,特别适合于迂曲的脑血管 ;其径向支撑力较差 ,在输送微导管时应防止其移位 ;其支架网眼较大 ,对血流动力学改变不明显 ,致密填塞是重要的 ,在输送弹簧圈时仍应防止弹簧圈畔进入载瘤动脉 ;术前、术后抗血小板药物的应用以及术后严格的系列造影随访是必要的。

Objective The Neuroform stent is the first self-expandable intracranial stent designed for the treatment of wide-necked intracranial aneurysms. We report the results of our preliminary experience in combination of this stent and detachable coils to treat patients with wide-necked intracranial aneurysms. Methods From August 2003 to August 2004, 22 patients with 24 wide-necked intracranial aneurysms were treated with combination of Neuroform stents and detachable coils. There are 19 acutely ruptured aneurysms and 5 unruptured aneurysms. Results Twenty-three aneurysms were successfully treated by combination of stents and detachable coils. In one patients with multiple aneurysms, an unruptured small wide-necked aneurysm was successfully treated with the stent deployment but failed coiling. All stents were deployed successfully. Mild stent displacement was found in one patient. Intraaneurysmal contrast media stagnation was not seen immediately after the stents deployment. Total (100%) obliteration of the aneurysm was achieved in 18 aneurysms, and subtotal (more than 90%) obliteration was achieved in 5 aneurysms. All the parent arteries were patency after treatment. In 2 aneurysms, some small coil loops were herniated into the parent artery from the stent struts but did not affect the blood flow within parent artery. No symptomatic brain ischemia was found in perioperative period. Seventeen patients were received a mean of 3 months follow-up and control angiography. No recurrence was found in 16 patients. Recanalization was found in one patient, he received a second embolization and the aneurysm was totally oberliterazation.Conclusions The Neuroform stent is a very safe and effective intracranial stent for treatment of wide-necked intracranial aneurysm. It is very suitable for wide-necked intracranial aneurysm with severely tortuous parent artery. Due to lack of significant radial strength of the stent, the stent can be shifted by a microguidewire or microcatheter when performed superselective catheterization. Because the big struts of this stent, the change of intraaneurysmal hemodynamics after stent deployment was notevident as coronary stent. So dense packing the aneurysm is advocated. Care must be taken when packing the detachable coils after the stent deployment. The administration of dual anti-platelet drug to prevent stent-related thromboembolic complications in the perioperative period is important. Although a good angiographic result is achieved, long-term angiographic follow-up is still necessary.