重叠低剖面可视化腔内支撑装置治疗颈内动脉血泡样动脉瘤的效果分析

Overlapping low-profile visualized intraluminal support device for blood blister-like aneurysm of the internal carotid artery

目的目前关于重叠低剖面可视化腔内支撑装置(LVIS)支架治疗颈内动脉血泡样动脉瘤(BBA)的报道较少。文中旨在对应用重叠LVIS支架辅助弹簧圈栓塞与其他支架辅助弹簧圈栓塞治疗BBA的效果进行了回顾性的分析。方法回顾性分析2015年2月至2017年2月南京军区南京总医院神经外科诊断为BBA并进行血管内介入治疗的15例患者资料。11例患者采用重叠LVIS支架辅助弹簧圈栓塞,4例患者采用非重叠LVIS支架辅助弹簧圈栓塞。根据Raymond分级统计术后即刻、术后1周治疗效果。随访时间2015年4月1日至2017年10月1日,分析影像学和临床随访结果。结果术后即刻闭塞情况:重叠LVIS支架辅助弹簧圈栓塞患者1级10例、3级1例;非重叠LVIS支架辅助弹簧圈栓塞患者1级3例、2级1例。术后1周闭塞情况:重叠LVIS支架辅助弹簧圈栓塞患者1级11例;非重叠LVIS支架辅助弹簧圈栓塞患者1级2例、2级2例。影像学随访结果:最后1次DSA随访闭塞情况,重叠LVIS支架辅助弹簧圈栓塞患者1级9例,2级1例;非重叠LVIS支架辅助弹簧圈栓塞患者1级1例、2级2例、3级1例。临床随访结果:重叠LVIS支架辅助弹簧圈栓塞患者mRS 0分9例、1分2例;非重叠LVIS支架辅助弹簧圈栓塞mRS 0分3例、1分1例;15例患者均预后良好。结论重叠LVIS支架辅助弹簧圈栓塞技术治疗BBA安全有效,值得临床推广。

Objective Reports are rarely seen on the treatment of blood blister-like aneurysm（BBA） of the internal carotid artery with the overlapping low-profile visualized intraluminal support device（LVIS） stent.This study was to investigate the effects of overlapping versus non-overlapping LVIS stent-assisted coiling in the treatment of BBA.Methods We retrospectively analyzed the clinical data about 15 cases of BBA of the internal carotid artery treated in our hospital from February 2015 to February 2017,11 by overlapping and the other 4 by non-overlapping LVIS stent-assisted coiling.Using Raymond-Roy Occlusion Classification（RROC）,we evaluated the effects of treatment immediately and at 1 week after operation.We followed up the patients from April 2015 to October2017 and analyzed the results of follow-up digital subtraction angiography（DSA） and modified Rankin Scale scores（mRS） of the patients.Results RROC showed 10 cases of grade Ⅰ and 1 case of grade Ⅲ occlusion in the overlapping group and 3 cases of grade Ⅰand 1 case of grade Ⅱ in the non-overlapping group right after operation.In comparison,there were 11 cases of grade Ⅰ in the overlapping group and 2 cases of grade Ⅰ and 2 cases of grade Ⅱ in the non-overlapping group at 1 week postoperatively.DSA at the end of the follow-up exhibited 9 cases of grade Ⅰ and 1 case of grade Ⅱin the overlapping group and 1 case of grade Ⅰ,2 cases of grade Ⅱ and 1 case of grade Ⅲ in the non-overlapping group.Satisfactory prognosis was observed in all the 15 cases,with mRS = 0 in 9 cases and mRS = 1 in 2 cases in the overlapping group and with mRS =0 in 3 cases in mRS = 1 in 1 case in the non-overlapping group.Conclusion Overlapping LVIS stent-assisted coiling is safe and effective for treatment of BBA of the internal carotid artery.