Willis覆膜支架与弹簧圈栓塞治疗颅段颈内动脉瘤效果的比较

Comparison between Willis covered stent placement and coil embolization in the treatment of cranial internal carotid artery aneurysm： a nonrandomized prospective trial

目的比较Willis覆膜支架和弹簧圈栓塞治疗颅段颈内动脉瘤的临床效果。方法89例经皮动脉穿刺行全脑选择性血管造影术证实的颅段颈内动脉瘤患者，根据其意愿分为A组43例，行Willis覆膜支架治疗；B组46例，行弹簧圈治疗。术后3、6、12个月及之后每年1次进行脑血管造影及临床随访，搜集血管造影及临床资料进行分析。对2组患者的手术成功率及并发症发生率进行X2检验，对即刻血管造影结果、手术时间、住院时间进行独立样本t检验。结果A组患者支架成功置人42例，失败1例；B组46例弹簧圈栓塞均获成功，2组差异无统计学意义（Fisher精确概率法，P=0．999）。即刻脑血管造影显示A组34例动脉瘤完全闭塞（81％），B组24例完全闭塞（52％）；平均手术时间A组（103±13）rain，B组（143±39）min，2组问差异有统计学意义（t=6．20，P〈0．01）。并发症A组6例，B组8例，2组差异无统计学意义（X。=0．20，P〉0．05）。A组41例随访6～41个月，脑血管造影显示39例动脉瘤完全闭塞（95％）；B组45例随访7—47个月，22例完全闭塞（49％），2组差异有统计学意义（P〈0．01）。最后一次随访结果显示，完全康复A组22例、B组27例，2组间差异无统计学意义（x。=0．352，P〉0．05）。结论脑血管造影结果显示Willis覆膜支架置入术治疗颅段动脉瘤的结果优于弹簧圈栓塞术，而临床表现2组无明显差别。

Objective To evaluate the clinical results of Willis covered stent implantation and coil embolization in the treatment of cranial internal carotid artery （ CICA ） aneurysm. Methods Eighty-nine patients with CICA aneurysms were selected for treatment with Willis covered stents （ n = 43, group A） or coil embolization （n = 46, group B） according to the patients＇will. Data on the technical success, initial procedure time and in-hospital interval, initial and final angiographic results, mortality, morbidity, and final clinical outcomes were collected and analyzed for the two groups at 6 months post-procedure. Results Endovascular covered stent placement and coil embolization were technically successful in all patients, except for one patient in group A. The initial angiographic results showed complete occlusion in 34 patients of group A （81%, 95% CI： 69%, 93% ） and24 patients of group B （52%, 95% CI： 37%, 67% ） （P〈 0. 05 ）. The final angiographic results indicated complete occlusion in 39 patients of group A （39/41,95% , 95% CI： 88% , 102% ） and 22 patients of group B （22/45,49%, 95% CI： 34% , 64% ,P 〈0. 01 ）. The average procedure time was（103 ±13）min in group A and （143 ± 39） rain in group B （P〈0.01）. No significant differences were seen between the two groups in technique success, mortality, morbidity, or final clinical outcomes. Conclusion In this nonrandomized, prospective trial, CICA aneurysm treatment with covered stents yielded midterm angiographie results that were superior to those of coil embolization.