瘤内微导管成袢技术在颅内动脉瘤支架辅助栓塞中的应用

Intra-aneurysmal looping technique of microcatheters for stent-assisted embolization of intracranial aneurysms

目的 探索支架辅助栓塞治疗颅内复杂颅内动脉瘤微导管超选新方法,分析动脉瘤内微导管成袢超选技术的安全性与可行性.方法 采用微导管瘤内成袢超选技术成功治疗21例复杂性颅内动脉瘤,通过交换技术成功将微导管和支架跨瘤颈释放,并进行弹簧圈填塞.结果 21枚动脉瘤均成功地植入支架.除1例发生末梢血管损伤出血以外,无一例发生动脉瘤破裂出血和载瘤动脉血栓或闭塞.7枚动脉瘤采用Tubridge血流导向装置治疗,其余14枚动脉瘤,致密栓塞或瘤颈残留12例,瘤体残留2例.术后所有患者均行临床及影像学随访.14枚动脉瘤接受DSA随访无一例复发;7枚接受MRA随访,3例复发.结论 动脉瘤内微导管成袢超选技术应用于支架辅助栓塞治疗复杂颅内动脉瘤是安全可行的,正确的材料选择和精准的操作是保证该技术成功实施的关键.

Objective To investigate the safety and feasibility of intra-aneurysmal looping technique for stent-assisted embolization of complicated intracranial aneurysms.Methods Twenty-one complicated intracranial aneurysms were treated successfully using intra-aneurysmal looping technique for stent-assisted coil embolization.Coil embolization was performed after the microcathetes and stents were implanted to cover the aneurismal neck using exchanging technique.Results Stents were implanted successfully in all of the 21 cases.The success ratio was 100%.Except for 1 case with perforation of distal vessels,none was suffered from rupture of the aneurysm or occlusion of its parent artery.Seven cases were treated using Tubridge flow diverters.Among the other 14 cases treated by conventional stents,the immediate results of dense embolization or neck residual were obtained in 12 cases and partial embolization in the other 2 cases.All cases received both clinical and radiological follow-up.None of the 21 cases developed new neurologic deficit during the follow-up period.Among them,14 cases were followed-up by digital subtraction angiography （DSA） and the results showed no recurrence.While the results of 7 cases followed-up by MRA showed recurrence in 3 cases.Conclusions Intra-aneurysmal looping technique of microcatheters for stent-assisted embolization was safe and feasible in the treatment of endovascular treatment of complicated intracranial aneurysms.Reasonable choice of the patients and materials were the promises of successful application of the technique.