高原地区颅内未破裂宽颈动脉瘤支架辅助弹簧圈栓塞治疗3年转归及与药物治疗相关性分析

The Outcome and Correlation Analysis of Plateau Unruptured Intracranial Wide-necked Aneurysms Stent Assisted Coil Embolization Treatment for 3 Years and Drug Treatment

目的观察使用支架辅助弹簧圈栓塞治疗高原地区颅内未破裂宽颈动脉瘤患者的长期预后。方法对2007年-2011年在青海省人民医院完成且接受随访的32例支架辅助弹簧圈栓塞颅内未破裂宽颈动脉瘤的久居高原患者,术后3年进行数字减影血管造影(digital subtraction angiography,DSA)明确支架内狭窄发生率、动脉瘤复发情况。调查术后抗血小板治疗情况。结果 32例患者中出现不同程度的支架内狭窄5例(15.6%),均为术后未规律服用阿司匹林患者。动脉瘤复发6例(18.8%),其中2例(6.3%)为小型前交通动脉瘤,患者动脉瘤体部分显影;4例(12.5%)为超过1.5 cm的颈内动脉虹吸段的大型动脉瘤。3年随访期内无一例患者因栓塞后动脉瘤破裂。结论支架辅助弹簧圈栓塞治疗高原颅内未破裂宽颈动脉瘤术式有效、可行,复发率较低,支架内狭窄发生率与术后抗血小板治疗不规范可能有关。

Objective To observe the long-term outcome of secondary coil embolization using Stent in the treatment of Unruptured Intracranial wide-necked aneurysms at high altitude. Methods The follow-up of secondary coil embolization of Intracranial unruptured wide-necked aneurysms in 32 patients with long residence in Plateau were completed in our hospital between 2007 and 2011. Three years after operation surgery for cerebral angiography under digital subtraction angiography （DSA） examinations was used to identify the rate of in-stent stenosis, recuurence rate of rupture of aneurysm, and post-operation anti-platelet treatment. Results Among 32 patients, there were 5 cases （15.6%） of in-stent stenosis of different degrees, who were patients that didn’t take aspirin regularly after operation; there were 6 cases （18.8%） of arterial aneurysms including 2 cases （6.3%） of small anterior communicating aneurysms; and 4 cases （12.5%） large aneurysms longer than 1.5 cm located at internal carotid siphon section. There was no anueurysms rupture because of embolism with 3-years’ follow-up period. Conclusion The plateau unruptured intracranial wide-necked aneurysms supported by the secondary coil embolization of intracranial unruptured wide-necked aneurysms is effective and viable with low relapse rates. The incidence of in-stent stenosis after its antiplatelet treatment might be closely related.