Willis覆膜支架治疗颈内动脉复杂动脉瘤

Willis covered stent for complex internal carotid aneurysms

目的 探讨国产Willis覆膜支架系统治疗颈内动脉复杂动脉瘤的安全性及有效性.方法 回顾性分析南方医科大学南方医院神经外科2013年11月至2015年5月单纯采用国产颅内Willis覆膜支架系统治疗8例复杂性颅内动脉瘤.其中颈内动脉血泡样动脉瘤3例,颈内动脉床突旁段动脉瘤2例,海绵窦段动脉瘤3例（1例创伤性假性动脉瘤,1例医源性假性动脉瘤,1例巨大动脉瘤支架辅助栓塞后复发）.术中根据血管条件,在保证载瘤动脉安全的前提下,尽可能将导引导管位置升高（靠近海绵窦段）,提供足够支撑,覆膜支架到位后再予释放栓塞动脉瘤.结果 8例颈内动脉复杂动脉瘤（8个动脉瘤）共置入8枚覆膜支架,其中7枚成功置入载瘤动脉.5例置入支架后即刻造影,显示病变完全消失,载瘤动脉通畅;1例支架辅助栓塞后复发的巨大海绵窦段动脉瘤置入1枚支架后,有少量对比剂漏入动脉瘤（内漏）.1例血泡样动脉瘤因颈内动脉迂曲,支架系统到位困难,术中发生医源性颈内动脉海绵窦瘘,球囊栓塞后予搭桥并载瘤动脉闭塞.其他病例无手术相关并发症.术后2 ～12个月对8例患者进行临床随访,均无神经功能障碍,改良Rankin量表（mRS）评分0分5例,1分2例,2分1例.3例术后6个月再次获得DSA随访,动脉瘤无复发,载瘤动脉通畅、无狭窄.结论 对于部分颈内动脉复杂动脉瘤,严格选择合适的病例,采用Willis覆膜支架治疗安全有效.

Objective To investigate the safety and efficacy of the Willis covered stent system for the treatment of complex internal carotid aneurysms.Methods Eight patients with complex internal carotid aneurysm treated with Willis covered stent system at the Department of Neurosurgery,Nanfang Hospital,Southern Medical University from November 2013 to May 2015 were analyzed retrospectively.Among them,3 patients had internal carotid artery blood blister like aneurysms,2 had paraclinoid segment aneurysms,and 3 had cavernous segment aneurysms （1 traumatic pseudoaneurysm,1 iatrogenic pseudoaneurysm,and 1 giant aneurysm）.According to the intraoperative condition of the paren artery,the guiding catheters were placed as high as possible （near the cavernous segment） to provide adequate support.After the covered stents were implanted.the balloon were inflated to release the stent and the aneurysm were eliminated at the same time.Results Eight patients with complex internal carotid aneurysm （8 aneurysms） were implanted 8 covered stents,7 of them were successfully released in the parent arteries.Angiography immediately after stenting in 5 patients showed that the lesions disappeared completely and the parent arteries were patent;After 1 stent was implanted,1 patient with recurrent giant aneurysm at the cavernous segment after stent-assisted embolization,a small amount of contrast agent leaked into the aneurysm （endoleak）.The stent system in place was difficult in 1 patent with blood blister like aneurysm because of his internal carotid artery tortuosity.Iatrogenic internal carotid cavernous fistula occurred during the operation.Bypass and occlusion of the parent artery was performed after balloon embolization.Other cases did not have operation-related complications.The 8 patients were followed up clinically at 2 to 12 months after procedure.They did not have any neurological deficits.The modified Rankin scale （mRS） scores were 0 in 5 cases,1 in 2 cases,and 2 in 1 case.Three patients got DSA followed-up again at 6 month after procedure.No recurrence of aneurysms was observed,and their parent arteries were patent without stenosis.Conclusion Willis covered stents were safe and effective for the treatment of some complex internal carotid artery aneurysms.