Solitaire AB支架辅助栓塞颅内动脉瘤临床随访研究

Solitaire AB stent-assisted endovascular embolization of intracranial wide-necked aneurysms: a clinical follow-up study

目的观察Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤初中期效果。方法回顾性分析2009年至2012年期间采用Solitaire AB支架辅助弹簧圈栓塞治疗的49例颅内宽颈动脉瘤患者49个动脉瘤,其中41例患者41个动脉瘤（26个破裂出血,15个未破裂）术后随访12~48个月,根据改良Rankin评分、DSA、CTA或MRA检查评价颅内动脉瘤影像学及临床结果。结果栓塞术后有2例动脉瘤再次破裂出血,3例脑梗死,1例载瘤动脉闭塞,死亡1例,并发症发生率为14.2%。栓塞术后12个月DSA、MRA或CTA检查显示,32个动脉瘤（32/41,78.0%）完全栓塞,明显高于术后即刻（21个,42.9%）（P=0.02）;瘤颈残留7个（17.1%）,部分栓塞2个（4.9%）,均较术后即刻有改善。24个动脉瘤（58.5%）稳定而无变化,复发4个（9.7%）。末次随访时改良Rankin评分显示0分18例（43.9%）,1分10例（24.4%）,2分5例（12.2%）,3分4例（9.8%）,4分2例（4.85%）,5分2例（4.85%）。患者日常活动能力自理率为80.5%,预后良好。结论 Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤安全有效,有助于提高完全栓塞率,降低操作相关并发症。

Objective To investigate the mid- term effect of Solitaire AB stent- assisted interventional embolization with spring coils for the treatment of intracranial wide- necked aneurysms. Methods During the period from May 2009 to April 2013, a total of 49 patients with intracranial wide- necked aneurysm（49aneurysms in total） received Solitaire AB stent-assisted interventional embolization treatment at authors＇ hospital.In 41 patients, a total of 41 aneurysms were detected, of which ruptured aneurysm with bleeding was confirmed in 26 and un- ruptured aneurysm in 15. These 41 patients were followed up for 12-48 months.Based on modified Rankin scoring and DSA, CTA or MRA manifestations, the clinical results were evaluated.Results After the embolization treatment, re-bleeding of the aneurysm occurred in 2 cases, cerebral infarction in 3 cases, occlusion of the parent artery in one case and death in one case; the occurrence rate of complications was 14.2%. DSA, MRA or CTA performed at 12 months after the embolization treatment,showed that 32 aneurysms（78.0%） were completely obstructed, which was obviously higher than that observed on DSA performed immediately after the embolization procedure（21 aneurysms, 42.9%）, the difference was statistically significant（P=0.02）; residue of aneurismal neck was seen in 7 cases（17.1%） and partial occlusion in 2 cases（4.9%）, which were much better than those observed on DSA that was performed immediately after the embolization procedure. Twenty- four aneurysms（58.5%） remained stable, showing no any change, and recurrence of aneurysm was observed in 4 cases（9.7%）. At the last follow- up exam, the modified Rankin scoring showed that 0 point was seen in 18 cases（43.9%）, one point in 10 cases（24.4%）, 2 points in 5 cases（12.2%）, 3 points in 4 cases（9.8%）, 4 points in 2 cases（4.85%） and 5 points in 2 cases（4.85%）. The self- care rate for daily activities was 80.5%, the prognosis was good. Conclusion For the treatment of intracranial wide- necked aneurysms, Solitaire AB stent- assisted interventional embolization with spring coils is safe and effective. This technique can improve the embolization rate and reduce the procedure- related complications.