Willis覆膜支架治疗颈内动脉床突上段破裂血泡样动脉瘤

Willis covered stent for treatment of ruptured blood blister-like aneurysms of supraclinoidal internal carotid artery

目的评估应用Willis覆膜支架血管内治疗颈内动脉床突上段破裂血泡样动脉瘤（BBA）的安全性和可行性。方法2013年12月至2015年12月同济大学附属同济医院介入科应用Willis覆膜支架治疗的位于颈内动脉床突上段破裂BBA患者，共13例（15个动脉瘤）。回顾性分析血管内治疗结果及术后并发症。结果13例（15个动脉瘤）患者共成功置入13枚支架。术后即刻造影显示，12例患者动脉瘤完全闭塞；1例轻度内漏，随访期内内漏自行闭塞。眼动脉闭塞2例，脉络膜前动脉闭塞1例，患者均无相关的神经功能障碍。手术过程中未出现血栓、动脉瘤破裂等并发症。术后13例随访4～6个月，平均（5．5±0．8）个月，血管造影见载瘤动脉通畅，未见动脉瘤复发；2例发生无症状的支架内轻至中度再狭窄；所有患者均未发生出血或缺血事件；改良Rankin量表评分0分8例，1分5例。结论Willis覆膜支架治疗颈内动脉床突上段破裂BBA安全有效，但仍需更长期的随访和大样本对照研究。

Objective To evaluate the safety and efficiency of endovascular Willis covered stent in treating ruptured blood blister-like aneurysms （BBAs） of supraclinoidal internal carotid artery. Methods During the period from December 2013 to December 2015, 13 patients with 15 ruptured BBAs of supraclinoidal internal carotid artery were treated with Willis covered stentsin Department of Interventional Radiology of Tongji Hospital affiliated to Tongji University. We retrospectively analyzed the patientsblinical data,endovascular treatment, surgicaloutcomes, complications and follow-up results. Results Thirteen stents were successfully delivered in thirteen patients with fifteen aneurysms. Immediate angiography after stent deployment revealed complete occlusion in 12 patients and minorendoleak in 1 patient, which had spontaneously resolved at the follow-up. In addition, occlusion of the ophthalmic artery was observedin 2 cases and occlusion of the anterior choroidal artery was demonstratedin 1 case without neurological dysfunctions. During the operation, no acute thrombosis, aneurysm rupture or other complications occurred in those patients. The mean follow-up period was 5.5 ± 0.8 months （ range 4 - 6 months ）. The follow-up angiography showed no stenosis in the parent arteryor aneurysm recurrence. Only two patients had mild to moderate asymptomatic in-stent stenosis. During the follow-up period, no bleeding or ischemie events were reported. The modified Rankin Scale was 0 in 8 patients and 1 in 5 patients. Conclusion Willis covered stentseems to be safe and effective for the treatment of ruptured BBAs of superclinoid internal carotid artery, which needs to be eonfirmedby longer follow-up and large-sample controlled studies.