支架辅助微弹簧圈栓塞治疗后交通宽颈动脉瘤

Stent-assisted microcoil embolization for posterior communicating wide-necked aneurysms

目的总结支架辅助微弹簧圈治疗后交通宽颈动脉瘤的经验。方法回顾性分析26例后交通宽颈动脉瘤的临床资料,其中破裂动脉瘤24例,未破裂2例;术前Hunt-Hess分级：0级2例,Ⅰ级8例,Ⅱ级7例,Ⅲ级8例,Ⅳ级1例。均采用支架辅助微弹簧圈治疗,手术前后给予常规抗凝。结果动脉瘤腔致密填塞20例,填塞90%以上3例,填塞90%以下3例。术中动脉瘤破裂出血2例,大脑前动脉血栓性脑梗死1例,颈内动脉痉挛1例,无死亡病例。23例随访6-48个月,平均15个月,DSA复查未发现支架塌陷、移位及微弹簧圈脱落、移位。结论采用支架辅助微弹簧圈可提高后交通宽颈动脉瘤腔的致密填塞率,并保持载瘤动脉通畅。

Objective To review the experience in stent-assisted microcoil treatment of posterior communicating wide-necked aneurysms.Methods Clinical data of 26 patients with posterior communicating wide-necked aneurysms were analyzed retrospectively,including ruptured aneurysms in 24,nonruptured in 2.The preoperative Hunt-Hess grade were as follows： grade 0 in 2 cases,grade Ⅰ in 8,grade Ⅱ in 7,grade Ⅲ in 8,grade Ⅵ in 1.Embolotherapy with stent-assisted microcoil was performed in all the patients,and antithrombotic therapy given before and after operation.Results Complete embolization was achieved in 20 patients,over 90% in 3 and less than 90% in 3.Intraoperative aneurysm rupture and bleeding occurred in 2 cases,atherothrombotic brain infarction of the anterior cerebral artery in 1,vasospasm of internal carotid artery in 1,and no patients died.Twenty-three patients were followed up for mean time of 15 months,ranged from 6 to 48 months.DSA found no collapse and displacement of stents and protrusion and shift of the microcoil.Conclusions Stent-assisted microcoil technique can increase complete embolization rate of posterior communicating wide-necked aneurysms and keep patency of the parent artery.