多支架联合弹簧圈栓塞治疗颅内梭形动脉瘤的临床技术和疗效探讨

Multiple overlapping stents combined with coils for the treatment of intracranial fusiform aneurysms: clinical technique and therapeutic results

目的：探讨多支架联合弹簧圈栓塞治疗颅内梭形动脉瘤的安全性及可行性。方法2012年8月-2013年8月收治3例颅内梭形动脉瘤患者，经头颈联合CTA及全脑血管造影确诊，采用多支架联合弹簧圈技术治疗并随访。结果3例患者均获手术成功，动脉瘤腔大部栓塞，术后即刻可见动脉瘤囊内涡流改变明显。术中共使用支架7枚，弹簧圈17枚，未出现动脉瘤破裂及血栓形成等情况。随访3～8个月，1例8个月后头痛消失，无神经功能障碍，复查造影可见动脉瘤腔消失，载瘤动脉通畅；1例3个月后头痛消失，复查造影可见动脉瘤腔少量显影，载瘤动脉通畅；1例3个月临床随访无症状。结论多支架联合弹簧圈栓塞治疗颅内梭形动脉瘤治疗方法具有可行性及安全性，近期疗效良好，长远疗效有待进一步随访。

Objective To investigate the safety and feasibility of multiple overlapping stents combined with coils in treating intracranial fusiform aneurysms, and to evaluate its therapeutic efficacy. Methods During the period from Aug. 2012 to Aug. 2013, three patients with intracranial fusiform aneurysm were admitted to authors’ hospital. The diagnosis was confirmed by CT angiography and whole cerebral angiography. Multiple overlapping stents combined with coils was carried out in all the three patients. All the patients were followed up and the clinical results were analyzed. Results Multiple overlapping stents combined with coils was successfully accomplished in all the three patients. Greater part of the aneurysmal cavity was occluded, and immediately after the procedure obvious blood whirling in the aneurysmal sac was seen. A total of 7 stents and 17 coils were used in treating the three patients. No aneurysm rupture or thrombosis occurred. The patients were followed up for 3 - 8 months. In one case the headache disappeared in 8 months, no dysneuria was detected, and angiography showed that the aneurysmal sac disappeared and the parent artery was patent. In another patient the headache disappeared in 3 months, and the angiography showed that the aneurysmal cavity had slight visualization and the parent artery was patent. The remaining patient was asymptomatic at 3-month follow-up. Conclusion For the treatment of intracranial fusiform aneurysms, multiple overlapping stents combined with coils is clinically feasible and safe with excellent short-term efficacy although its long-term results need to be further studied. （J Intervent Radiol, 2014, 23： 277-280）.