不同支架置入方式辅助栓塞颅内分叉部宽颈动脉瘤的疗效

The effect of embolization assisted with varying stent release methods in the treatment of intracranialwide-neck bifurcation aneurysms

目的探讨不同支架置入方式辅助栓塞颅内分叉部宽颈动脉瘤（WNBA）的安全性及疗效。方法回顾性纳入2012年5月至2017年5月郑州大学第一附属医院神经介入科采用不同支架置入方式辅助栓塞的颅内WNBA患者，共62例。其中采用“冰激凌”技术14例，“Y”型支架技术29例，“x”型支架技术1例，LVIS支架“Barrel”技术18例。结果62例患者中，除1例拟采用“Y”型支架者未成功外，其余手术均获成功。术后即刻Raymond分级I级者30例（48．4％），U级者21例（33．9％），11I级者11例（17．7％）。围手术期7例（11．3％）发生并发症，其中缺血性6例（9．7％），术中血栓形成2例（3．2％），术后急性缺血性并发症4例（6．4％）；5例为采用“Y”型支架技术，1例为采用LVIS支架“Barrel”技术。术后丘脑出血1例（1．6％）。临床随访59例，随访时间为5-57（11．9±1．7）个月。其中改良Rankin量表评分（mRS）0-1分55例（93．2％），2-3分2例（3．4％），4-5分2例（3．4％）。影像学随访33例，随访时间为3—36（6．9-4-1．2）个月，其中18例（54．6％）动脉瘤不显影，5例（15．2％）改善，9例（27．3％）稳定，1例（3．0％）复发需要再次治疗。结论不同支架置人方式辅助弹簧圈栓塞治疗WNBA，技术可行性和安全性均可接受；短期疗效较好，远期疗效需进一步观察。

Objective To investigate the safety and efficacy of embolization assisted with varying stent release methods in the treatment of intracranial wide-neck bifurcation aneurysms （WNBA）. Methods A retrospective analysis was conducted on 62 patients with WNBA treated with varying stent release methods at Department of Neuro-intervention, the First Affiliated Hospital of Zhengzhou University from May 2012 to May 2017. Among them, 14 patients were treated with ＂waffle cone＂ technique, 29 with double stents in ＂Y＂ configuration, 1 with double stents in ＂X＂ configuration and 18 with LVIS ＂Barrel＂ technique. Results Except 1 case that failed to be treated with ＂Y＂ configuration, the others underwent successful operations. According to the Raymond classification, the immediate pro（：edural outcome was Class I in 30 （48.4%） patients, Class II in 21 （33. 9%） and Class HI in 11 （17.7%）. Perioperative isehemic complications occurred in 6 （ 9.68% ） cases including intraoperative thrombosis in 2 cases and acute ischemic complications post operation in 4. Postoperative thalamic hemorrhage was reported in 1 （ 1.6% ） case. Clinical follow-up lasted for 5 - 57 months, with an average of 11.9 ±1.7 months. For 59 cases, the mRS （modified Rankin scale） score was 0 - 1 in 55 （93.2%） cases, 2 - 3 in 2 （3.4%） and 4 - 5 in 5 （3.4%）. Angiographic follow-up at 3 -36 months in 33 cases showed that aneurysms were completely occluded in 18 （54.6%） , improved in 5 （ 15.2% ） and remained stable in 9 （27.3%）. There was 1 （3.0%） case with aneurysm reeanalization that needed retreatment. Conclusions The technical feasibility and safety of embolization assisted with varying stent release methods could be accepted for treatment of intracranial WNBA. However, further studies are needed for evaluation of its long-term efficacy.