LVIS支架辅助栓塞颅内未破裂动脉瘤的临床疗效

Clinical effect of LVIS stent-assisted coiling of unruptured intracranial aneurysms

目的 探讨应用LVIS支架辅助弹簧圈栓塞颅内未破裂动脉瘤的安全性和有效性.方法 回顾性纳入第四军医大学唐都医院神经外科2015年11月至2016年11月收治的62例颅内未破裂动脉瘤患者,所有患者均采用LVIS支架辅助弹簧圈栓塞治疗.分析患者的临床表现、动脉瘤的部位及大小、术后即刻Raymond分级、围手术期并发症及行术后定期随访,以评估手术疗效.结果 62例患者共78个动脉瘤,其中68个采用单LVIS支架辅助栓塞,6个采用双LVIS支架辅助栓塞,3个采用LVIS 3支架辅助栓塞,1个采用Neuroform支架＋LVIS支架呈“Y形”辅助栓塞.术后即刻数字减影血管造影显示,78个动脉瘤中,Raymond Ⅰ级39个（50.0％）,Ⅱ级23个（29.5％）,Ⅲ级16个（20.5％）.围手术期并发症的发生率为4.8％（3/62）.术中1例患者动脉瘤破裂出血,对症治疗后恢复良好;1例患者穿支血管破裂,术后继发支架内血栓形成死亡.术后1例患者非动脉瘤性出血死亡.60例患者随访时间为4 ～ 13个月,平均（7.2±3.1）个月.影像学随访32例（44个动脉瘤）,完全栓塞率达70.5％ （31/44）.1例（2.3％）轻度复发,继续临床观察.电话随访28例（32个动脉瘤）,临床症状均恢复良好.结论 应用LVIS支架辅助弹簧圈栓塞颅内未破裂动脉瘤的临床治疗安全有效,中期随访结果良好.

Objective To investigate the safety and efficacy of the LVIS stent-assisted coiling of unruptured intracranial aneurysms.Methods We retrospectively analyzed 62 patients who underwent LVIS stent-assisted coiling treatment for unruptured intracranial aneurysms at Department of Neurosurgery,Tangdu Hospital,Fourth Military Medical University,between November 2015 and November 2016.Demographic and clinical factors,including initial clinical presentation,risk factors,location and size of aneurysm,Raymond Classification following initial treatment as well as perioperative complications,were documented.Regular follow-up of the cases was conducted post operation to assess the surgical outcomes.Results The 62 patients in this study had a total of 78 unruptured intracranial aneurysms.Among them,62 aneurysms were treated with single LVIS stent,6 aneurysms with double LVIS stents,3 aneurysms with 3 LVIS stents,and 1 aneurysm was treated with Neuroform stent and LVIS stent ＆quot; Y＆quot;-shaped assisted coiling.Raymond Classification following initial treatment indicated that 30 cases （50%） were in class 1,23 cases （29.5%） in class 2 and 16 cases （20.5%） in class 3.The incidence rate of perioperative complications was 4.8% （3/62）.Hemorrhagic event of aneurysmal rupture occurred in 1 patient during coiling who received symptomatic treatment and recovered at discharge.Perforator puncture occurred in 1 case during coiling,and the patient died from secondary in-stent thrombosis formed post procedure.One patient died from nonaneurysmal postprocedural rebleeding.Sixty cases were followed up for 4-13 months with a mean of 7.2 ± 3.1 months.Imaging was followed up in 32 cases with 44 aneurysms.Based on Raymond scale,31 out of 44 （70.5%） aneurysms belonged to class 1 （complete occlusion）.Mild recurrence was reported in 1 （2.3%） case which received continuous clinical observation.Twenty-eight patients with 32 aneurysms were followed up by telephone and recovered well.Conclusion Endovascular treatment of unruptured intracranial aneurysms with LVIS stentassisted coiling is suggested to be safe and effective,and the mid-term follow-up results seems satisfactory.