电解脱Solitaire支架在颅内动脉瘤栓塞治疗中的应用

Application of electric detachable stent in the embolization therapy of intracranial aneurysms

目的评估电解脱Solitaire支架辅助栓塞颅内宽颈及夹层动脉瘤的有效性和安全性。方法回顾分析2010年8月至2012年1月利用Solitaire支架辅助栓塞38例患者40个颅内宽颈和夹层动脉瘤的治疗和预后。其中男性12例，女性26例；年龄21～78岁，平均55岁。患者均行全脑血管造影检查，证实为宽颈动脉瘤31例，夹层动脉瘤9例。颅内动脉瘤破裂致蛛网膜下腔出血29例，其中自发性蛛网膜下腔出血28例，入院Hunt—Hess分级，I级1例，Ⅱ级20例，Ⅲ级4例，Ⅳ级3例；外伤性颅内动脉瘤1例。垂体瘤术中动脉瘤出血1例，未破裂颅内动脉瘤8例。动脉瘤位于颈内动脉后交通段21个，颈内动脉床突上段6个，颈内动脉海绵窦段3个，前交通复合体1个，椎动脉9个。患者术后6个月进行DSA检查及GOS评分评价预后。结果共应用Solitaire支架40个，均成功释放，但术中急性血栓形成3个，均予支架回收。Raymond栓塞分级，完全栓塞31个（77．5％），瘤颈残留5个（12．5％），部分栓塞4个（10．0％）。随访时间3～12个月，中位时间6个月。末次随访DSA检查患者均未出现动脉瘤复发，行GOS预后评分，患者预后良好34例，轻残3例，死亡1例。结论应用Solitaire支架辅助栓塞宽颈和夹层动脉瘤是安全的，而且当术中急性血栓形成后可有效地将支架及血栓回收取出，恢复载瘤动脉的通畅性，降低手术并发症。

Objective To evaluate the efficacy and safety of SolitaireTM AB nem＇ovascular stenting- assisted coil embolization for patients with wide-necked or dissecting aneurysms. Methods The clinical results and prognosis from a consecutive series of 38 patients with 40 wide-necked or dissecting aneurysms aneurysms who treated by SolitaireTM AB neurovascular stenting-assisted coil embolization from August 2010 to January 2012 was retrospectively analyzed. There were 12 male and 26 female patients, the age was 21-78 years （mean 55 years）. Thirty-one cases were confirmed wide-neck aneurysms and 9 cases were dissection aneurysms by DSA. Acute subarachnoed hemorrhage due to the rupture of aneurysms was seen in 28 cases（ according Hunt-Hess scale, 1 case of Class [ ,20 cases of Class lI ,4 cases of Classm, 3 cases of Class lV）, I case was traumatic intracranial aneurysm, 1 case was misdiagnosed during the operation of pituitary adenoma by the approach of transsphenoid, and unruptured anem^csms were seen in 8 cases. The aneurysms were located at the posterior communicating segment of internal carotid artery （ 21 cases）, the supraclinoid segment of internal carotid artery （6 cases） , the cavernous segment of internal carotid artery （3 cases） ,the anterior communicating artery （ 1 case）, and the vertebral artery （9 cases ）. The patients were performed DSA and Glasgow outcome score （GOS） to evaluate the prognosis 6 months after surgery. Results Forty stents were used and all remodeling device were achieved successful position. Owing to acute thrombosis in 3 patients, the stents were retrieved successfully. The proportion of patients in whom Raymond class 1 occlusion was obtained in 31 cases（77.5% ） , Raymond class 2 occlusion in 5 cases （ 12.5% ） and Raymond class 3 occlusion in 4 cases （ 10. 0% ）. The follow-up was 3 to 12 months（ median 6 months）. The results of DSA indicated none of the patients＇anuerysm was recurred; and GOS was applied to evaluate the prognosis of patients after 3 months. Of 38 patients, 34 recovered well, 3 moderately disabled, 1 patient died. Conclusions It is safe to emholize aneurysms with SolitaireTM AB neurovascular stenting-assisted coil; meanwhile, the stents can be retrieved when acute thrombosis to reduce the complications.