支架辅助弹簧圈栓塞治疗前交通动脉宽颈动脉瘤

Stent-assisted coil embolization for the treatment of wide-necked anterior communicating artery aneurysms

目的：探讨支架辅助弹簧圈栓塞治疗前交通动脉（ anterior communicating artery, ACoA）宽颈动脉瘤的可行性、安全性和有效性。方法对2011年7月至2014年11月期间采用支架辅助弹簧圈栓塞治疗的 ACoA 宽颈动脉瘤患者的资料进行回顾性分析,总结临床和影像学效果,重点关注围手术期并发症。结果采用支架辅助弹簧圈栓塞治疗 ACoA 宽颈动脉瘤29例,其中2例因为支架不能到位释放而放弃介入治疗。介入治疗即时效果显示,完全栓塞21例（78%）,近全栓塞5例（19%）,部分栓塞1例（3%）；术中血栓形成3例（溶栓后均实现血管再通,其中1例死于溶栓后脑出血）,脑血管痉挛1例,动脉瘤破裂1例,大脑前动脉远端破裂1例。27例术后接受临床随访,随访时间2～36个月,平均17个月,无出血性或缺血性并发症；16例接受影像学随访,随访时间6～12个月,平均7个月,无动脉瘤复发病例。结论尽管存在一定的风险,支架辅助弹簧圈栓塞治疗 ACoA 宽颈动脉瘤总体上是可行、安全和有效的。

Objective To investigate the feasibility, safety and efficacy of the stent-assisted coil embolization for the treatment of wide-necked anterior communicating artery （ACoA） aneurysms. Methods From November 2011 to November 2014, the clinical data of the patients with wide-necked ACoA aneurysms treated by using the stent-assisted coil embolization were analyzed retrospectively. The clinical and radiographic effects were summarized. The perioperative complications were focused on. Results The ACoA wide-neck aneurysms of 29 patients were treated with stent-assisted coil embolization. Two of them abandoned the interventional treatment because of stents could not be in place and release. The immediate results of interventional treatment showed that 21 were embolized completely （78% ）, 5 were near totaly embolized （19% ）, and 1 was partialy embolized （3% ）. Three patients had intraoperative thrombosis （recanalization achieved after thrombosis, one of them died of cerebral hemorrhage after thrombolysis）. One patient suffered cerebral angiospasm, one had aneurysm rupture, and one had distal rupture of the anterior cerebral artery. Twenty-seven patients received clinical folow-up, and the folow-up time ranged from 2 to 36 months （mean 17 months）. None of the patients had hemorrhagic or ischemic complications. Sixteen patients received imaging folow-up, and the folow-up ranged from 6 to 12 months （mean 7 months）. None of the aneurysms had recurrence. Conclusions Stent-assisted coil embolization of wide-necked ACoA aneurysm is overal feasible, safe, and effective although there are certain risks.