载瘤动脉内单个支架置入治疗前循环未破裂宽颈微小动脉瘤的短期疗效

Short-term outcome of single stenting technique for unruptured wide-necked tiny aneurysms of the anterior circulation

目的 探讨载瘤动脉内单个支架置入治疗前循环未破裂宽颈微小动脉瘤的短期疗效.方法 2008年1月至2013年7月北京医院神经外科采用载瘤动脉单个支架置入治疗11个前循环未破裂宽颈微小囊状动脉瘤,动脉瘤最大径为2.0 ～3.0 mm,平均（2.4 ±0.4）mm;宽/颈比均≤1.2;颈内动脉床突段2个、后交通动脉起始部4个、脉络膜前动脉起始部2个、大脑中动脉水平段分叉部3个;所有颈内动脉动脉瘤均位于颈内动脉内侧和（或）腹侧壁.随访时通过血管造影复查与门诊或电话随访,统计动脉瘤闭塞与破裂出血情况.结果 9个动脉瘤按计划直接行载瘤动脉单纯支架置入,另2个在载瘤动脉支架置入后试行弹簧圈栓塞但微导管插管未成功.共成功置入10枚支架,其中1枚支架同时治疗2个串联的动脉瘤.仅1个动脉瘤术后即刻造影显示变小.无围手术期并发症发生.所有动脉瘤随访时间8～24个月,平均（13±6）个月,8个动脉瘤大小无改变,2个变小,仅1个动脉瘤完全闭塞;变小或闭塞的3个动脉瘤均存在载瘤动脉的无症状性支架内再狭窄.临床随访无动脉瘤破裂出血.结论 对于前循环有分支动脉发出部位的未破裂、宽颈微小动脉瘤,载瘤动脉内单个支架置入虽然安全,可作为治疗选择之一,但短期随访闭塞率低.

Objective To evaluate the short-term outcome of single stenting technique for unruptured,wide-necked,tiny aneurysms of the anterior circulation.Methods Eleven unruptured,widenecked,tiny aneurysms of the anterior circulation were treated by a single stent deployed in the parent artery between January 2008 and July 2013 in Department of Neurosurgery in Beijing Hospital.The maximum diameter of the aneurysms ranged from 2.0 to 3.0 mm,mean （2.4 ± 0.4） mm,and the dome-to-neck ratios were all ≤ 1.2.The locations were clinoid segment of internal carotid artery （n =2）,posterior communicating artery origin （n =4）,anterior choroidal artery origin （n =2） and middle cerebral artery bifurcation （n =3）.All internal carotid aneurysms were located in the medial and/or ventral wall of the internal carotid artery.The rate of aneurysm obliteration and rupture during follow-up was obtained by repeat angiography and clinic or telephone interview respectively.Results Sole stent placement in the parent artery was intentionally performed for nine aneurysms,while attempt of coiling after stent deployment for the other two aneurysms failed due to unsuccessful microcatherization.Ten stents were successfully deployed,of which one was used to treat two tandem lesions simultaneously.Only one aneurysm became smaller immediately postprocedure.No perioperative complications occurred.Angiographic follow-up after a mean period of （13 ± 6）months （range 8-24 months） revealed that 8 aneurysms did no change in size,2 became smaller and only one was totally occluded.Asymptomatic in-stent stenosis of the parent artery was found in all 3 shrinking or occluded aneurysms.No aneurysm rupture was observed in the clinical follow-up.Conclusion For those unruptured,wide-necked,tiny aneurysms arising at branching sites in the anterior circulation,single stenting technique seems to be a safe alternative treatment,while the short-term rate of aneurysm occlusion is low.