国产Willis覆膜支架治疗复杂性颅内动脉瘤的疗效及长期随访

Domestic Willis covered stent in the treatment of complex intracranial aneurysms:efficacy and long-term follow-up

目的评价国产Willis覆膜支架系统治疗复杂性颅内动脉瘤患者的安全性及远期疗效。方法 2006年10月—2007年9月,复旦大学附属华山医院神经外科单纯采用国产颅内Willis覆膜支架系统,治疗7例复杂性颅内动脉瘤,其中颈内动脉海绵窦段3例,颈内动脉眼动脉段1例,4例均为大型宽颈动脉瘤;颈内动脉后交通段复发动脉瘤1例,椎动脉小脑后下动脉下段大型夹层动脉瘤2例。结果①对7例(7个动脉瘤)患者共置入9枚覆膜支架,其中8枚成功置入载瘤动脉。对5例置入支架后即刻造影,显示病变完全消失,载瘤动脉通畅;1例巨大海绵窦段动脉瘤置入1枚支架后,有少量对比剂漏入动脉瘤(内漏);1例椎动脉瘤置入第1枚支架内漏明显,再置入1枚支架后好转。②术中发生颅内远端血管破裂出血1例,经开颅手术清除血肿后痊愈。其他病例无手术相关并发症。③术后5～12个月对7例患者均行临床及DSA随访,均无神经功能障碍。2例有内漏者,1例消失,1例仍有少量内漏,但较术后即刻明显好转;7例均无动脉瘤复发,载瘤动脉通畅。5例术后45～55个月再获得DSA随访,动脉瘤无复发,载瘤动脉通畅、无狭窄。1例失访,1例非动脉瘤性死亡。结论对部分复杂性颅内动脉瘤,采用Willis覆膜支架治疗安全有效,长期疗效较好。

Objective To evaluate the safety and long-term efficacy of the domestic Willis covered stent system in the treatment of the patients with complex intracranial aneurysms.Methods Seven patients with complex intracranial aneurysms were treated in the Department of Neurosurgery,Huashan Hospital,Shanghai Fudan University by using domestic Willis covered stent system only from October 2006 to September 2007.The aneurysms in 3 patients were at the cavernous segment of the internal carotid artery,1 at the ophthalmic segment of the internal carotid artery,and the 4 aneurysms were all large wide-necked aneurysms;1 patient had recurrent aneurysm at the posterior communicating segment of the internal carotid artery and 2 had large dissecting aneurysms at the lower segment of the posterior inferior cerebellar artery of the vertebral artery.Results ①Nine covered stents were released in the aneurysms of 7 patients（7 aneurysms）,8 stents were released successfully in the parent arteries.Angiography immediately after 1 stent was released in 5 patients showed that the aneurysms disappeared completely and the parent arteries were patent.After 1 stent was implanted in 1 patient with giant aneurysm at the cavernous segment,a small amount of contrast agent leaked into the aneurysm（endoleak）;after the first stent was implanted into the vertebral artery aneurysm in 1 patient,the endoleak was obvious,and it was improved after another one was implanted.②One patient had intracranial distal vascular rupture during the operation and it was cured after craniotomy to remove the hematoma.③The clinical and DSA follow-up were performed in the 7 patients at 5 to 12 months after operation.They did not have any neurological deficits.DSA showed 2 patients had endoleak,1 endoleak disappeared and the other still had a small amount of endoleak,but it was obviously improved compared to immediately after operation;7 patients did not have recurrent aneurysms and their parent arteries were patent.Five patients were followed up with DSA again at 45 to 55 months after operation,no recurrence of aneurysm was observed,their parent arteries were patent,and no stenosis occurred.One patient was lost to follow-up and one was dead but not related to the aneurysms.Conclusion Willis covered stent is an effective treatment tool for some complex intracranial aneurysms and its long-term efficacy is good.