Gore覆膜支架治疗自发性颈内动脉颅外段动脉瘤的临床应用

Clinical application of Gore stent graft for the treatment of spontaneous extracranial internal carotid artery aneurysms

目的 探讨应用Gore覆膜支架介入治疗自发性颈内动脉颅外段动脉瘤的方法,评估其治疗效果.方法 本组共6例患者,其中男4例,女2例.术前规范口服硫酸氢氯吡格雷75 mg及拜阿司匹林100 mg每日,共服用3d.术中采用同轴技术泥鳅导丝引导Neuro导管通过颈内动脉颅外段至动脉瘤远端,Amplatz交换导丝由Neuro导引导管送至颈内动脉动脉瘤以远作为支架输送支撑导丝,撤出导引导管后将Gorge覆膜支架经由Amplatz交换导丝送至动脉瘤远端,释放支架行动脉瘤段颈内动脉成型术,术后3个月复查造影.结果 本组共6例患者共8枚动脉瘤,治疗7例次,颅内缺血起病4例,颅内出血起病1例,1例查体发现,其中左侧病变3例,右侧病变2例,双侧病变1例.本组患者5例支架到位满意,支架释放后血管成型好,无动脉瘤显影,复查病例无复发及管腔狭窄;1例因局部血管过度迂曲支架无法到位改行手术治疗.结论 Gore覆膜支架治疗颈内动脉颅外段动脉瘤具有微创、操作简便、疗效肯定的优点,尤其适合于长节段动脉瘤及近颅底段病变.

Objectives To investigate the methods of using Gore stent graft for minimally invasive treatment of spontaneous extracranial internal carotid artery aneurysms and to evaluate its efficacy.Methods There were 6 patients in this group,including 2 females and 4 males.Before procedure,the patients orally took clopidogrel bisulfate 75 mg and aspirin 100 mg once a day for 3 days.Using the coaxial technique,loach guidewire guided Neuro catheter through the extracranial segment of internal carotid artery to distal aneurysm during the procedure.Amplatz exchange wire was delivered through a Neuron guiding catheter to the distal internal carotid artery aneurysm as the stent delivery support guidewire.After the withdrawal of the guiding catheter,the Gore stent graft was delivered to the distal aneurysm via the Amplatz exchange wire and the stent was released for internal carotid artery angioplasty of the aneurysmal segment.Angiography was reexamined at 3 months after procedure.Results There were 6 patients with 8 aneurysms in this group.They were treated for 7 times.Four patients had intracranial ischemia and one had intracranial hemorrhage.One was found during the physical examination.The lesions in 3 of them were on the left sides,2 were on the right sides,and 1 had bilateral lesions.The stents of 5 patients were in place satisfactorily in this group.The angiopoiesis was good after stent releasing.There was no aneurysm development.The patients had no recurrence and luminal stenosis after reexamination.The stent of one patient failed in place because of local vascular excessive tortuosity and was treated with surgery.Conclusions Gore stent graft for the treatment of extracranial internal carotid artery aneurysms has the advantages of mini-invasion,simple operation,and definite curative effect,especially suitable for the long segment aneurysm and the lesions near the segment of skull base.