支架辅助技术在颅内宽颈动脉瘤栓塞中的应用

Application of stent-assisted coiling for intracranial wide-necked aneurysms

目的探讨血管内支架辅助弹簧圈治疗颅内宽颈动脉瘤的技术要点、并发症防治,评估该技术的安全性及疗效。方法回顾性分析应用30只支架辅助栓塞治疗27例29个颅内宽颈动脉瘤的临床资料。结果 1例支架半释放时支架出现变形,2例弹簧圈术中出现移位,其中1例以1支架覆盖并固定,另1例移位至大脑中动脉远端。1例患者用1只支架覆盖2个毗邻的小宽颈动脉瘤,其中1个动脉瘤支架覆盖后再以弹簧圈填塞。余病例术中均成功释放支架并使用弹簧圈填塞。全部病例术毕即刻造影显示动脉瘤闭塞>90%27个。16例临床随访1～7个月,均无再出血或血栓栓塞的症状。全脑血管造影随访5～7个月共6例示支架无移位,动脉瘤无再显影。结论颅内支架的使用为宽颈动脉瘤的治疗提供了一种可行的解决方案,但支架的置入存在一定风险,其长期疗效有待于进一步观察与随访。

Objective To investigate the technical details, complications prevention, safety and efficacy of stent-assisted coiling for intracranial wide-necked aneurysms. Methods The clinical outcomes and CT and angiographic follow-ups of 27 patients with 29 wide-necked aneurysms undergoing stent-assited coiling using 30 Enterprise stents were retrospectively evaluated. Results Stent deformation occurred in one case during full-deployment. Two coils migrated into parent arteries during the operation, one was covered by a stent steadily, the other migrated to the distal end of MCA. Two neighboring aneurysms in one case were covered with one stent, one of the aneurysms was packed with coils. Over 90% occlusions were achieved in 27 aneurysms in immediate postoperative angiography. No re-bleeding or symptom related to thrombosis occurred during clinical follow-up for 1-7months in 16 patients. Follow-up angiography in 6 cases showed no stent migration or recanalization. Condusion Stent-assisted coiling provides a feasible solution for intraeranial wide-necked aneurysms, while the risk of stenting exists and long-term outcomes need further observation and follow-up.