SolitaireAB支架结合弹簧圈治疗颅内宽颈动脉瘤的初步经验

SolitaireAB stent-assisted coiling of intracranial wide-necked aneurysms: preliminary experience

目的评价SolitaireAB支架结合弹簧圈治疗颅内宽颈动脉瘤的安全性及有效性。方法2010年9月至2012年3月,应用SolitareAB支架结合弹簧圈治疗28例(30枚)颅内宽颈动脉瘤,其中破裂出血动脉瘤17枚、未破裂动脉瘤13枚。术后进行序列的脑血管造影及临床随访。结果所有支架均成功释放。手术直接相关并发症发生2例(6.7%),其中致残1例(3.3%)。疾病相关死亡2例(6.7%),无手术相关死亡。动脉瘤即刻栓塞结果按Raymond分级:Ⅰ级25枚,Ⅱ级2枚,Ⅲ级3枚。随访20例,时间6个月～2年(平均13个月),均无新增神经功能障碍及再出血。出院后3个月mRS评分:0～1分17例、2分1例。复查造影显示动脉瘤完全栓塞17枚(85%)、复发3枚,其中小、中型动脉瘤(直径<10 mm)仅1枚复发(5%),2枚巨大动脉瘤(直径≥25 mm)均复发(100%)。结论 SolitaireAB支架具有足够的径向支撑力,操作相对简便。SolitaireAB支架结合弹簧圈栓塞颅内宽颈动脉瘤安全、有效,其长期疗效有待更长期随访和多中心研究。

Objective To evaluate the safety and efficacy of SolitaireAB stent-assisted endovascular coil embolization in treating intraeranial wide-necked aneurysms and to introduce the preliminary experience in its clinical application. Methods During the period from September 2010 to March 2012, SolitaireAB stent- assisted endovascular coil embolization was carried out in 28 patients with intracranial wide- necked aneurysms （30 lesions in total） in authors＇ hospital. Of the 30 intracranial wide-necked aneurysms, ruptured aneurysm with bleeding was seen in 17 and unruptured aneurysm in 13. A series of cerebral angiographies were performed after the treatment and follow-up was conducted. The clinical data as well as the angiographic findings were analyzed. Results All stents were successfully delivered. Procedure- related complications occurred in two cases （6.7%） and one of them became disabled （3.3%）. Disease-induced death was seen in two patients （6.7%） and no procedure- related death occurred. According to Raymond grading for the immediate occlusion result of the aneurysm, complete obliteration （grade I） was obtained in 25 lesions, residual neck （grade Ⅱ ） in 2 and residual aneurysm （grade m ） in 3. Twenty patients were followed up for 6 - 24 months （mean 13 months）, and no newly-developed neurological dysfunction or re-bleeding was observed during the follow-up period. At three months after the procedure, the level of mRS score was 0 - 1 in 17 patients and 2 in one patient. Follow-up examinations with angiography showed that complete embolization of the aneurysm was obtained in 17 lesions （85%） and recurrence was seen in 3 lesions （15%）. In small or medium-sized aneurysms （diameter 〈 10 ram） group only one lesion had recurrence （5%）, while all the twogiant aneurysms （diameter ≥ 25 mm） developed recurrence （100%）. Conclusion SolitaireAB stent has sufficient radial force and it is easily to be operated. SolitaireAB stent- assisted endovascular coilembolization is a safe and effective treatment for intracranial wide-necked aneurysms, although its long-term effectiveness needs to be further clarified with long-term follow-up observation and multi-eenter clinical trials. （J Intervent Radiol, 2013, 22： 447-450）