Silk血流导向支架联合弹簧圈治疗颅内复杂动脉瘤的短期疗效

Efficacy of Silk flow diverters in combination with coils for treatment of intracranial aneurysms: a short-term observation

目的 探讨Silk血流导向支架治疗颅内复杂动脉瘤的初步疗效.方法 回顾性分析首都医科大学宣武医院2010年4月1日-2011年10月30日应用Silk支架治疗30例颅内动脉瘤患者的临床资料,其中男11例、女19例,年龄为29～71岁,平均（51.7±11.7）岁.30例动脉瘤患者有31个动脉瘤,30个动脉瘤位于颈内动脉,除1例患者床突上段有两个动脉瘤为小动脉瘤（分别为3 mm×4 mm和2 mm×2 mm）外,其余均为大型或巨大型动脉瘤（最大径 〉15 mm）,左椎动脉颅内段基底动脉夹层动脉瘤1例.结果 ①30例患者中3例置入2枚Silk,1例置入3枚Silk,其余患者置入1枚Silk.1例（3.3%）支架未能到位,治疗失败,1例（3.3%）第3天出现蛛网膜下腔出血,停抗血小板聚集药物后3个月复查DSA,显示同侧颈内动脉闭塞,1例治疗后第19天消化道出血,停用抗凝药物后出现脑梗死.②17例（56.7%）患者获得了6个月的DSA随访,动脉瘤完全或几乎消失2例（11.8%）,动脉瘤及颈内动脉同时闭塞的患者3例（17.6%）,动脉瘤部分显影的患者12例（70.6%）.结论 对使用常规弹簧圈难以致密栓塞的大型动脉瘤、宽颈动脉瘤或不规则形状的动脉瘤,Silk支架提供了一种治疗方法,但短期内动脉瘤闭塞率较低,其远期效果尚有待于进一步的随访.

Objective To investigate the preliminary efficacy of Silk flow diverters for the treatment of complex intracranial aneurysms. Methods The clinical data of 30 patients with intraeranial aneurysms treated with Silk flow diverters from April 1, 2010 to October 30, 2011 were analyzed retrospectively. Ele ven patients were males and 19 were females, aged 29 to 71 （ mean 51.7 ± 11.7 ） years. There were 31 aneurysms in 30 patients,30 aneurysms were on the internal carotid arteries, 1 patient had 2 small aneu- rysms （3 mm× 4 mm and 2 mm×2 mm respectively） on the elinoid segments of internal carotid ar- tery, the rest were large or giant aneurysms （ the maximum diameter 〉 15 ram）. One patient also had a left vertebrobasilar artery dissecting aneurysm. Results Three of the 30 patients were implanted 2 Silk flow diverters, 1 was implanted 3 Silk flow diverters, and the others were implanted 1 Silk flow diverter. The stent of one patients （3.3%） was failed in place and one （3.3%） had subarachnoid hemorrhage at day 3. At 3 months after stopping antiplatelet drugs, DSA reexamination showed ipsilateral internal carotid artery occlusion. One patient had gastrointestinal bleeding at day 19. After stopping anticoagulants, the pa- tient had cerebral infarction.②17 patients （56.7%） were followed up for 6 months with DSA. The aneu- rysms were completely or almost disappeared in 2 patients （ 11.8% ）, both aneurysms and internal carotid artery were occluded in 3 patients, and part development of aneurvsms was in 12 patients （70.6%）.Conclusion As for the large wide-necked or irregularly shaped aneurysms difficult to densely pack with conventional coils, the Silk flow diverters have provided a treatment method, however, the aneurysm occlu- sion rate in short term is low, and its long-term effect needs to be further followed up.