覆膜支架治疗颅内动脉疾病

Covered stent implantation for the treatment of intracranial arterial disorders

近年来覆膜支架治疗颅内动脉疾病的报道渐多,由冠脉覆膜支架的临床应用过渡到专用颅内覆膜支架的基础研究和临床试验。应用覆膜支架治疗的颅内动脉疾病主要为巨大、宽颈或微小脑动脉瘤、各种原因所致的颅内动脉假性动脉瘤、椎基底动脉梭形或夹层动脉瘤和海绵窦动静脉瘘等。这类颅内动脉的病变是目前手术和血管内治疗材料和技术难以解决的。覆膜支架使用后可直接、有效封堵动脉瘤颈和瘘口,使梭形动脉瘤及载瘤血管再塑形。但也会产生脑神经功能缺失、穿支或母体血管闭塞。本文对覆膜支架治疗颅内动脉病变的国内、外应用和研究动态,所治疗的疾病部位和类型、治疗效果及存在问题进行回顾性分析。

The coronary covered stents have been more and more used to treat intracranial arterial diseases for recent years,and the hot point in study has gradually changed from clinical application of coronary covered stents to the fundamental and clinical trial of specially-designed intracranial covered stents.The covered stents are mainly employed for the treatment of intracranial arterial disorders,including giant,wide-necked or minute cerebral aneurysms,intracranial pseudoaneurysms caused by a variety of reasons,fusiform or dissecting aneurysms of vertebral-basic artery,and internal carotid cavernous fistula,etc.It is very difficult for current surgical or endovascular treatment,both materially and technically,to deal with the above mentioned intracranial disorders.The covered stent can restore the anatomic shape of artery by direct sealing the aneurysmal neck and the fistula.The complications of covered stent treatment include defect of cranial nerves,occlusion of parent artery or branches.This article aims to review the related medical literature published both at home and abroad,to make a retrospective analysis of the therapeutic results,and to put forward some issues of common interest.