LVIS支架辅助栓塞急性期破裂颅内宽颈动脉瘤

Application of LVIS stent in endovascular treatment of acutely ruptured intracranial wide-necked aneurysms

目的探讨LVIS支架辅助弹簧圈栓塞急性期破裂颅内宽颈动脉瘤的安全性和有效性。方法回顾性纳入菏泽市立医院神经外科2014年1月至2016年6月应用LVIS支架在急性期辅助栓塞治疗48例（共48枚动脉瘤）破裂颅内宽颈动脉瘤，分析其临床资料、手术相关并发症、动脉瘤栓塞程度以及临床和影像学随访结果。结果48例动脉瘤的支架均完全释放（100％）。术后即刻栓塞结果：RaymondI级栓塞25例（52．1％），Ⅱ级栓塞18例（37．5％），Ⅲ级栓塞5例（10．4％）。4例支架内血栓形成，其中2例发生在术中，2例发生在术后24h内，给予盐酸替罗非班治疗后血栓消失，其中1例遗留永久性偏瘫。1例支架未完全打开，给予球囊扩张后血流明显改善。2例患者的动脉瘤在术中破裂出血，经继续填塞弹簧圈后出血控制。其中39例（81．2％）术后行影像学随访，平均随访（7．8±3．6）个月（6～11个月），35例动脉瘤完全闭塞（89．7％）。3例动脉瘤稳定（7．7％），1例动脉瘤复发（2．6％）。术后所有动脉瘤均未发生再出血。46例经6个月随访，疗效良好者（mRS评分0～2分）38例，疗效不良者（mRS评分3～5分）8例，良好率为82．6％（38／46）。结论LVIS支架在辅助栓塞急性期颅内宽颈动脉瘤安全可行，为其治疗提供了新材料。但其长期效果仍需进一步研究。

Objective To evaluate the safety and efficacy of LVIS stent-assisted embolization of acutely ruptured intra-cranial wide-necked aneurysms. Methods Forty-eight patients with acutely ruptured intracranial wide-necked aneurysms treated with LVIS stent-assisted embolization at Department of Neurosurgery, Heze Municipal Hospital from January 2014 to June 2016 were enrolled into this study. The clinical data, procedure-related complications, embolization rate of aneurysms, imaging follow-up results and clinical outcomes of the 48 patients were analyzed retrospectively. Results The stents of 48 patients were released completely （ 100% ）. Raymond grade I embolization was achieved in 25 cases （52.1% ） , Raymond grade U embolization in 18 cases （37.5%） , and Raymond grade lU embolization in 5 cases （ 10.4% ）. Four patients had in-stent thrombosis including 2 cases occurring in the process of embolization and 2 occurring within 24 hours post embolization. Following treatment with tirofiban hydroehloride, the thrombosis disappeared and permanent hemiplegia remained in 1 patient. Incomplete stent expansion was seen in 1 patient and improved after dilatation by balloon. Two aneurysms ruptured in the operation and were secured by subsequent coiling. Among the 39 （ 81.2% ） patients who underwent angiographie follow-up lasting 6 - 11 months （ mean： 7.8±3.6 months）, 35 （89.7%） patients gained complete occlusion, 3 （7.7%） , 3 aneurysms were stable and 1 （2.6%） reported recurrence of aneurysm. No rebleeding occurred in all aneurysms at the 6-month follow-up. Thirty-eight patients had good outcome （modified Rankin scale, mRS： 0-2）, 8 reported poor effect （mRS： 3 -5）, and the rate of good outcome was 82. 6%. Conclusions Application of LVIS stent-assisted embolization of acutely ruptured intraeranial wide-necked aneurysms is suggested to be safe and feasible. Further research is needed to detemline the long-term stability of stents after embolization.