Wingspan支架辅助弹簧圈栓塞治疗症状性载瘤动脉狭窄合并未破裂动脉瘤

Wingspan stent-assisted coiling of intracranial aneurysms with symptomatic parent arteries stenoses: experience with mid-term follow-up results in 35 patients

目的探讨Wingspan支架辅助弹簧圈栓塞治疗症状性载瘤动脉狭窄合并未破裂动脉瘤的临床疗效。方法回顾性分析Wingspan支架辅助弹簧圈栓塞治疗的35例颅内未破裂动脉瘤合并症状性载瘤动脉狭窄患者的临床资料,分析手术技术成功率、操作相关并发症、造影和临床随访结果。结果 35例患者技术成功率为100%;术后载瘤动脉平均残余狭窄率为17.4%;操作相关致残率为5.7%(2/35);动脉瘤完全栓塞25例(71.4%),次全栓塞7例(20.0%),不全栓塞3例(8.6%)。35例患者临床随访1 d^37月,平均18.3个月;终点事件(病变血管供血区域发生的卒中或死亡)发生率为11.4%(4/35)。31例患者脑血管造影平均随访10.6个月,支架内再狭窄率为12.9%(4/31),动脉瘤再通率为6.5%(2/31)。结论 Wingspan支架辅助弹簧圈栓塞治疗症状性载瘤动脉狭窄合并未破裂动脉瘤具有较好的临床疗效。

Objective To assess the efficacy and safety of Wingspan stent-assisted coils embolization of intracranial aneurysms with symptomatic parent arteries stenoses. Methods Thirty-five consecutive patients （19 men, 16 women; age range, 48-79 years; mean age, 60.4 years） with 35 unruptured wide-necked or fusiform intracranial aneurysms （mean size, 6.8 mm; range, 2.5-18 ram） complicated by symptomatic parent arteries stenoses （mean stenosis degree, 71.1%; stenosis range, 50%-92%） were treated by the Wingspan stent-assisted coiling. The technical feasibility of the procedure, procedure-related complications, angiographic results, clinical outcome and follow-up angiography were evaluated. Results The stents were successfully implanted into the stenosed parent arteries and the aneurysms were successfully embolized by the coils in all the patients. The degree of stenosis decreased to 17.4% after the stenting. The angiography immediately after the embalization demonstrated complete occlusion in 25 cases （71.4%）, neck remnant in 7 cases （20.0%）, and incomplete occlusion in 3 cases （8.6%）. There was permanent neurological defect in 2 patients （5.7%, 2/35） after the procedure. The following-up from 1 day to 37 months （mean, 18.3 months） showed that ischemic stroke occurred in 2 patients 15 days after the operation. The occurrent rate of the end events including the overall frequency of any stroke, intracranial hemorrhage, or death within 30 days or ipsilateral stroke beyond 30 days was 11.4% （4/35）. The rupture of the aneurysms did not recur in all the patients. The angiography during following-up showed that more than 50% in-stent restenosis occurred in 4 patients and the aneurysms recanalization occurred in 2 patients. Conclusion The effects of Wingspan stent-assisted coil embolization on intracranial aneurysms with parent arteries stenoses are good.