Enterprise支架辅助栓塞治疗颈内动脉眼动脉段动脉瘤的疗效分析

Effect of Enterprise stent assisted coil embolization in the treatment for ophthalmic artery aneurysms of the internal carotid artery segment.

目的探讨Enterprise支架辅助弹簧圈栓塞术治疗颈内动脉眼动脉段动脉瘤的方法、可行性及预后。方法共收集40例颈内动脉眼动脉段动脉瘤患者,其中男性16例,女性24例,年龄21～70岁,平均52岁。Hunt-Hess分级评估:Ⅰ级9例;Ⅱ级15例;Ⅲ级9例;Ⅳ级6例;Ⅴ级1例。36例患者使用Enterprise支架辅助弹簧圈栓塞术治疗,4例行单纯弹簧圈栓塞术治疗,术后行眼动脉段动脉瘤3D-DSA造影,观察动脉瘤闭塞效果。术后随访患者24个月左右,应用格拉斯哥预后评分(Glasgow Outcome Scale,GOS)进行疗效评价。结果 40例眼动脉段动脉瘤完全闭塞37例,大部分闭塞2例,小部分闭塞1例。36枚Enterprise支架均被成功释放,4枚支架释放过程中出现移位现象,辅助弹簧圈栓塞治疗术后35例无并发症;行单纯弹簧圈栓塞术治疗眼动脉段动脉瘤共4例,1例术后发生视力障碍,1例术后发生视野缺损、轻度残疾。统计分析显示:Enterprise支架辅助弹簧圈栓塞治疗眼动脉段动脉瘤比行单纯弹簧圈栓塞术治疗发生较少并发症(χ2=4.512,P=0.041),且患者预后恢复优、GOS评分高(χ2=3.971,P=0.043)。结论应用血管内Enterprise支架辅助微弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤,闭塞效果好,术后并发症较少,患者预后恢复良好。

Objective To investigate the methods, feasibility and prognosis of Enterprise stent assisted coil embolization in the treatment of ophthalmic artery aneurysms of the internal carotid artery segment. Methods The clinical data of 40 patients diagnosed as ophthalmic artery aneurysms in our hospital from March 2010 to September 2012 was collected, including 16 males and 24 females, aged 21-70 years old （52 in mean）. Thirty-six patients were treated with stent assisted coil embolization, and 4 patients were treated coil embolization exclusively. Hunt-Hess grade evaluation showed 9 cases in Ⅰ grade, 15 cases in Ⅱ grade, 9 cases in Ⅲ grade, 6 cases in Ⅳ grade and 1 case in Ⅴ grade. Digital subtraction angiography of the three-dimensional imaging （3D-DSA） and Glasgow Outcome Scale （GOS） were applied to speculate the occlusion effect of different treatment in ophthalmic artery aneurysms and the complications after operation by fullow-up visit. Results Thirty-six Enterprise stents were successfully released, and 4 stents （11.1%） shifted automatically in the releasing process （2 stents forward and 2 stents afterward automatically）. Thirty-seven cases （92.5%） were embolized completely, 2 eases were embolized subtotally, and 1 was embolized partially. Thirty-five of the 36 cases （97.2 %） who were treated with stent assisted coil embolization had no severe complications, but 1 patient suffered vision disorder and 1 patients suffered slight disability accompany with defective of visual field respectively after operation. Statistical analysis showed that there were less complications to treat ophthalmic artery aneurysms by Enterprise stent assisted coil embolization than coil embolization exclusively （χ^2=4.512, P= 0.041）, with better prognosis and GOS fraction （χ^2= 3.971 ,P=0.043）. Conclusion The ophthalmic artery anenrysms of internal carotid artery segments can be densely embolized by Enterprise stent assisted coil embolization, with fewer postoperative complications and better recovery of patients.