Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤36例

Endovascular embolization of intracranial wide-necked aneurysms by using Solitaire AB stent as well as coils:an initial experience in 36 patients

目的探讨Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤的经验和疗效。方法 2010年5月至2011年3月使用Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤患者36例39个动脉瘤,其中动脉瘤破裂出血15例。动脉瘤位于前交通动脉1个,颈内动脉后交通段13个,眼动脉段13个,海绵窦段4个,椎动脉颅外段1个,椎动脉颅内段4个和基底动脉顶端3个。术后3个月和12个月复查脑血管造影评价疗效。结果共采用Solitaire AB支架38个辅助弹簧圈治疗39个宽颈动脉瘤,栓塞成功率为100%。术中15个支架回收调整位置,双支架5例,其中联合Neuroform3支架3例,联合Enterprise支架2例;术后即刻造影示完全栓塞30个,次全栓塞9个,术中1例患者支架轻度回撤,无动脉瘤破裂出血和血栓事件发生。术后血管造影随访27例,延迟性弹簧圈移位1例,完全栓塞病例中无再通病例,次全栓塞病变中6个达到完全栓塞,所有载瘤动脉通畅,支架内无明显狭窄,术后所有患者均无再出血。结论 Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤的初步经验和结果令人鼓舞,此法方便、安全、有效。

Objective To discuss the preliminary experience and clinical results of endovascular embolization by using Solitaire AB Stent as well as coils for the treatment of intracranial wide-necked aneurysms.Methods During the period from May.2010 to March 2011 Solitaire AB stent-assisted coil embolization was carried out in 36 patients with 39 intracranial wide-necked aneurysms.Acute subarachnoid hemorrhage due to the rupture of aneurysm was seen in 15 cases.The aneurysms were located at the anterior communicating artery（n = 1）,at the posterior communicating segment of internal carotid artery（n = 13）,at the ophthalmic segment of internal carotid artery（n = 13）,at the cavernous segment of internal carotid artery（n = 4）,at the extra-cranial segment of vertebral artery（n = 1）,at the intracranial segment of vertebral artery（n = 4） or at the basilar top（n = 3）.The clinical results were evaluated with cerebral angiography at 3 and 12 months after the treatment.Results A total of 38 Solitaire AB stents were used to assist coil embolization management of 39 intracranial wide-necked aneurysms,and the technical success rate was 100%.During the procedure,15 stents needed to be retrieved and repositioned after initial full deployment,and double stenting was performed in 5 cases.After endovascular treatment immediate angiography showed that total occlusion was seen in 30 aneurysms and subtotal occlusion in 9 aneurysms.During the whole procedure,the stent moved back slightly in 1 case,and no evident thromboembolic or rebleeding events occurred.Follow-up angiography was conducted in 27 cases,which showed that delayed coil migration occurred in one case,all the aneurysms that had been totally embolized remained occluded,and 6 of the aneurysms that had been sub-totally embolized became totally occluded.No in-stent stenosis nor aneurysmal re-bleeding occurred.Conclusion The preliminary experience and clinical results of endovascular embolization by using Solitaire AB Stent as well as coils for the treatment of intracranial wide-necked aneurysms are highly encouraging.The technique is very simple,safe and effective.