支架置入治疗大脑中动脉动脉瘤相关血管形态改变

Vascular change due to endovascular stent placement for middle cerebral artery aneurysm

目的血流动力学因素和颅内动脉瘤的转归密切相关,血流动力学因素和血管形态相互影响。研究支架置入对大脑中动脉动脉瘤血管形态改变,探讨支架相关血管形态变化对血流动力学因素和动脉瘤转归的影响。方法回顾分析2006年1月至2011年1月间采用支架辅助治疗的大脑中动脉动脉瘤患者DSA资料。在支架置入前后的二维影像上,分别测量载瘤动脉流入段与流出段中轴线夹角,计算角度变化。结果纳入本研究的33例患者中在支架植入后均有明显的载瘤动脉几何形态学改变,支架相关血管角度增加5.5°~56.4°平均（20.7°±9.56°）。结论支架植入可以明显改变载瘤动脉形态,可能通过降低载瘤动脉曲率使局部血流动力学趋向生理水平,进而提高动脉瘤的介入治疗效果。

Objective Hemodynamics has been shown to play an important role in the initiation and progress of intracranial aneurysm,and is considered well related to vascular configuration.The purpose of this study was to quantify the vascular angle change due to intracrnaial stent placement and its effect on hemodynamics.Methods Between January 2005 and January 2011,imaging data of patients with wide-necked middle cerebral artery（MCA） aneurysm,treated with stent-assisted coiling,were retrospectively analyzed.33 patients with a wide-necked MCA aneurysm were treated with stent-assisted coiling and stent alone.The angle between the afferent vessels and the efferent vessels was calculated to determine the exact change in the angle after stenting.Results In all 33 patients,the stent caused a clear change in the geometry of the parent vessel.Stent-related vascular angle change ranged from 5.6～56.4 degrees,with an average of（20.7±9.56） degrees.Conclusions Stent placement for MCA aneurysms has a substantial effect on the vascular geometry,may resulting in local hemodynamic changes.