支架治疗颈内动脉分叉部宽颈动脉瘤

Stent implantation for the treatment of wide-necked aneurysms located at internal carotid artery bifurcation

目的初步评价支架治疗颈内动脉分叉部宽颈动脉瘤的可行性、安全性和有效性。方法收集2004年1月至2010年12月11例颅内动脉瘤患者,共检出16枚颅内动脉瘤。其中位于颈内动脉分叉部的11枚动脉瘤均为宽颈动脉瘤,动脉瘤直径2.5～18 mm。所有患者采用不同类型支架及支架技术治疗,并于术后1、3、6、12个月进行随访。结果治疗中采用不同类型支架11枚,其中球扩支架1枚,自膨胀支架10枚。动脉瘤即刻栓塞结果按Raymond分级.Ⅰ级4枚,Ⅱ级2枚,Ⅲ级5枚。未发生手术相关并发症,出院时改良Rankin评分0～1分11例。11例患者随访1～108个月,均病情稳定,无新发的神经功能障碍。影像学随访7例,随访时间1～48个月,动脉瘤不显影4例,改善2例,稳定1例。结论对于颈内动脉分叉部宽颈动脉瘤,支架治疗技术可行,且安全有效,长期疗效有待于进一步研究。

Objective To preliminarily evaluate the feasibility, safety and efficacy of stent placement for the treatment of wide-necked aneurysms located at internal carotid artery bifurcation. Methods Eleven patients with wide-necked aneurysms located at internal carotid artery bifurcation, who were encountered during the period from Jan. 2004 to Dec. 2010 in hospital, were collected. A total of 16 intracranial aneurysms were detected, of which 11 were wide-necked and were located at internal carotid artery bifurcation. The diameters of the aneurysms ranged from 2.5 mm to 18 ram. Individual stent type and stenting technique was employed for each patient, Fallow-up at 1, 3, 6 and 12 months after the procedure was conducted. Results A total of 11 different stents were successfully deployed in the ~eleven patients. The stents included balloon expandable stent （n = I ） and self-expanding stent （n = 10）. According to Raymond grading for the immediate occlusion of the aneurysm, grade I （complete obliteration） was obtained in 4, grade I[ （residual neck） in 2 and grade llI （residual aneurysm） in 5 cases. No procedure-related complications occurred. At the time of discharge, the modified Rankin score was 0 - 1 in the eleven patients. During the follow-up period lasting for 1 - 108 months, all the patients were in stable condition and no newly-developed neurological dysfunction or bleeding was observed. Follow-up examination with angiography （1 - 48 months） showed that the aneurysms were cured （no visualization） in 4 cases, improved in 2 cases and in stable condition in one case. Conclusion For the treatment of wide-necked aneurysms located at internal carotid artery bifurcation, stent implantation is clinically feasible, safe and effective. Further studies are required to evaluate its long-term efficacy.