Y型支架辅助技术在颅内动脉分叉部宽颈动脉瘤治疗中的应用

Application of Y-configuration stent technique to treatment of intracranial wide-neck bifurcation aneurysms

目的 探讨Y型支架辅助弹簧圈栓塞颅内动脉分叉部宽颈动脉瘤的疗效。方法 回顾性分析2012年10月至2015年10月采用Y型支架辅助弹簧圈栓塞的16例颅内动脉分叉部宽颈动脉瘤的临床资料,均采用闭环Enterprise支架,其中采取并行Y型支架技术9例,交叉Y型支架技术7例。结果 均成功采用Y型支架辅助弹簧圈技术完成动脉瘤的栓塞,技术成功率为100%;1例术前Hunt-Hess分级4级的基底动脉分叉部宽颈动脉瘤因严重脑血管痉挛于术后第二天死亡;1例术后出现一过性神经功能缺失,6个月复查造影见分叉部一分支主干闭塞;1例基底动脉末端大动脉瘤瘤体有复发;余13例经CTA或DSA随访1个月－3年均无再出血及动脉瘤复发。结论 Y型支架辅助技术是治疗颅内动脉分叉部绝对宽颈动脉瘤的有效方法,近期动脉瘤瘤体及瘤颈均达到致密填塞,远期疗效还需进一步观察。

Objective To investigate the clinical characters of intracranial wide-neck bifurcation aneurysms and evaluate the safety and clinical outcomes of treatment with Y-stent-assisted coils. Methods The clinical data of 16 patients with intracranial wide-neck bifurcation aneurysms treated by Y-stent-assisted coils from October, 2012 to October, 2015 was analyzed retrospectively. Results Of 16 consecutive patients undergoing successful Y-stent assisted coiling, 9 were treated by kissing Y-stent technique and 7 by crossing Y-stent technique. The aneurysms were completely occluded in all the patients （100%）. One patent with Hunt-Hess grade 4 died from severe cerebral vasospasm 2 days ＇after the operation. The mild neurological deficit occurred after the operation in 1 patient, in whom the occlusion of one main branch of bifurcation was observed by DSA 6 months after the operation. DSA showed that a large basilar apex bifurcation aneurysm recanalized 6 months after the operation. No rebleeding and recanalization of the aneurysms occurred in 13 patients who were followed up by DSA or CTA from 1 month to 3 years. Conclusions Y-stent-assisted coiling is an effective method to treat the complex intracranial wide-neck bifurcation aneurysms when single stent-assisted coiling is not feasible and sufficient. The long-term effect of Y-stent-assisted coiling on the wide-neck bifurcation aneurysms still should be further observed.