支架辅助弹簧圈栓塞颅内后交通宽颈动脉瘤长期疗效

Long-term follow-up on stent-assisted coil embolization for intracranial posterior communicating artery wide-necked aneurysm

目的:探讨颅内后交通宽颈动脉瘤的类型、支架辅助栓塞治疗的策略及长期随访疗效。方法:回顾性总结我院2006年5月至2011年11月经支架辅助栓塞的82例83个后交通宽颈动脉瘤。分析动脉瘤形态和大小、支架种类选择、患者预后及随访疗效等资料。结果:82例患者中,男37例,女45例。后交通宽颈动脉瘤形态主要有囊状、柱状、锥型和不规则型四种形态,分别为26、23、18和16个,其中1例为双侧后交通镜像宽颈动脉瘤。所选用支架包括Winspan、Enterprise、Neuroform及Solitaire支架。支架植入及弹簧圈填塞技术成功率100%,支架辅助弹簧圈栓塞术中出血3例,死亡1例,均为锥型宽颈动脉瘤,术后肢体偏瘫1例,另1例恢复良好。GOS预后评分:5级73例,4级4例,3级和2级各2例,1级1例。随访57例,随访时间1月4.5年,动脉瘤复发5例,3例给予补充填塞治疗,2例继续观察。结论:根据后交通宽颈动脉瘤不同类型,并采取恰当的支架辅助弹簧圈栓塞策略治疗后交通宽颈动脉瘤安全有效。

Objective To investigate the type of intracranial posterior comumnicating artery wide-necked aneurysm （Pcom-AN） and the effect of stent-assisted coil embolization for Pcom-AN. Methods The retrospective study included 82 cases with 83 Peom-AN hnspitalized in Guangdong General Hospital from May 2006 to November 2011. Tile data on size and shape of Pcom-ANs, the type of stents, the morphous of parental artery, the selection of coil and follow-up of cases were collected and used for analysis. Results Thirty-seven male and 45 female cases were included in this study. There were four types of aneurysms in posterior communicating artery wide-necked aneurysms, including cystic form, prismatical form, pyramid and irregular type aneurysms with 26, 23, 18 and 16 cases, respectively. One case was shown with bilateral Peom-ANs. Four types of stents, including Winspan, Enterprise, Neuroform and Solitaire, were used in this study. The technique of achievement ratio within the procedure of stent deployment and coiling was 100%. Three cases with bleeding in the coiling procedure, and 1 of them died. Three cases were all pyramid type aneurysms. One case suffered hemiparalysis after the procedure and another one had a good recovery. About GOS score： 73 cases were in 5 grade, 4 cases were in 4 grade, 2 cases were in 3 grade, 2 eases were in 2 grade and one case was in 1 grade. Fifty-seven cases of followed up were performed from 1 month to 4.5 years. The reeurrence happened in 5 eases, 3 of them were coiling again and 2 of them were tracted al follow-up. Conclusion According to the different types of Pcom-ANs, to take suitable stentassisted coiling strategy based on the different type of aneurysms was sale and effective.