摘要
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.
出处
《中华神经外科杂志》
CSCD
北大核心
2018年第1期50-54,共5页
Chinese Journal of Neurosurgery
关键词
动脉瘤
破裂
支架
栓塞
治疗性
治疗结果
Aneurysm, ruptured
Stents
Embolization, therapeutic
Treatment outcome