新型自膨式颅内支架Enterprise在西藏高原治疗宽颈破裂颅内动脉瘤中的应用

Application of novel intracranial self-expandable Enterprise stent to treatment of intracranial wide-necked aneurysms in Tibetan plateau

目的总结在西藏高原地区利用新型颅内专用支架Enterprise经血管内介入治疗破裂出血的宽颈颅内动脉瘤的疗效及围手术期的处理。方法 6例破裂出血的颅内宽颈动脉瘤患者均行数字减影血管造影(DSA)检查确诊,并根据动脉瘤的特点实施个性化血管内介入治疗,其中5例行支架辅助铂金弹簧圈栓塞术,1例行单纯支架贴敷术。结果 6例中完全栓塞4例,次全栓塞1例,单纯支架贴敷1例。术中复查DSA显示:动脉瘤显影消失5例,单纯支架置入后瘤腔内对比剂滞留1例。1例术后出现对侧肢体偏瘫(肌力0级),经治疗后,肌力恢复(上肢V-级、下肢V级)。除术前Hunt&HessⅣ级、Glasgow4分的1例因继发肺部感染、脑积水恢复至Hunt&HessⅢ级、Glasgow 7分继续留院治疗外,其余5例均恢复正常。门诊随访1～5个月,无再出血或缺血事件发生。结论高原地区利用Enterprise经血管内介入治疗破裂出血的宽颈颅内动脉瘤是安全、有效、可行的,但围手术期的抗凝及抗血小板聚集治疗需注意高原低氧因素的影响。

Objective To investigate the therapeutic effects of a novel intracranial Enterprise stent on ruptured hemorrhagic intracranial wide-necked aneurysms,and to summarize the experiences of perioperative anticoagulation and antiplatelet management.Methods The clinical data of 6 cases of ruptured hemorrhagic intracranial wide-necked aneurysms were retrospectively analyzed.They were all confirmed by digital subtraction angiography（DSA）and undergone individualized endovascular interventional treatment according to the characteristics of each aneurysm.Among them,stent assisting coil embolization was performed in 5 cases and sole stent implanting in 1 case.Results The aneurysms were completely embolized in 4 cases,sub-completely embolized in 1 case,and sole stent was implanted in 1 cases.DSA showed that the aneurysms were disappeared in 5 cases,and the contrast agents detained in the cavity of aneurysms in 1 case following sole stent implanting.Postoperative hemiplegia of contralateral limbs occurred in 1 case with muscle strength of 0 grade which recovered to V grade in lower limb and nearly V grade in upper limb after treatment.Except that 1 case in which Hunt Hess was only improved from preoperative grade Ⅳ to grade Ⅲ and Glasgow coma scale（GCS）from preoperative 4 points to 7 points due to secondary pulmonary infection and hydrocephalus was still treated in hospital,the other 5 cases recovered very well.No re-bleeding or ischemic event was occurred during follow-up for 1 to 5 month.Conclusion Endovascular interventional treatment of ruptured hemorrhagic intracranial aneurysms with Enterprise stent in Tibetan plateau is safe,mini-invasive,effective and feasible,but the perioperative management of anticoagulation and antiplatelet must pay attention to influences caused by high-altitude hypoxia.