LVIS及Enterprise两种支架辅助弹簧圈治疗椎动脉夹层动脉瘤的疗效分析

Efficacy analysis of LVIS and Enterprise stent assisted coil in the treatment of vertebral artery dissection aneurysm

目的 观察及评价LVIS支架与Enterprise支架辅助弹簧圈栓塞治疗椎动脉夹层动脉瘤的疗效.方法 回顾性分析了2013年1月至2017年6月北京天坛医院神经介入科采用LVIS支架与Enterprise支架辅助弹簧圈治疗椎动脉夹层动脉瘤96例.其中采用LVIS支架辅助弹簧圈治疗(LVIS组)28例,Enterprise支架辅助弹簧圈治疗(Enterprise组)68例.术后进行临床和影像学随访.分析对比两组间的即刻栓塞率、手术并发症及复发率.结果 术后即刻造影显示:LVIS支架组椎动脉夹层动脉瘤完全闭塞17个(60.7%),近全栓塞10个(35.7%),部分栓塞1个.Enterprise支架组椎动脉夹层动脉瘤完全闭塞27个(39.7%),近全栓塞34个(50.0%),部分栓塞7个.LVIS支架组有3例(10.7%)患者发生手术相关并发症,Enterprise支架组3例.术后6~12个月行数字减影血管造影(DSA)随访,10个椎动脉夹层动脉瘤出现了复发.其中LVIS组2个(11.1%),Enterprise支架组有8个(15.1%).临床随访3.1~74.9个月,末次临床随访中:mRS评分:0分55例,1分13例,2分1例,3分1例,6分1例.其中,LVIS支架组中,所有随访患者预后均良好(100%);Enterprise支架组中预后良好50例(94.4%).结论 支架辅助弹簧圈治疗椎动脉夹层动脉瘤完全和近全栓塞率较高,神经并发症发生率较低,预后较好.LVIS支架组相对Enterprise支架组栓塞率较高,复发率低,预后较好,但手术并发症发生率较高.

Objective To observe and evaluate the therapeutic efficacy of LVIS stent and Enterprise stent assisted coil in embolization of vertebral artery dissection aneurysm (VDA).Methods Clinical data of 96 patients with VDAs treated by LVIS stent and Enterprise stent assisted coil were analyzed retrospectively between January,2013 and June,2017.Of all,the LVIS stent assisted coil was performed in 28 patients (LVIS-stent group) and Enterprise in 68 patients (Enterprise-stent group).The clinical and imaging follow-up were performed.The instant embolization rate,complications,and recurrence rate were analyzed and compared between the two groups.Results Instant angiographic results:in the LVIS stent group,complete occlusion was achieved in 17 VDAs (60.7%),near-complete occlusion in 10VDAs (35.7%),and partial occlusion in 1 VDA (3.6%).In the Enterprise stent group,complete occlusion was achieved in 27 VDAs (39.7%),near-complete occlusion in 34VDAs(50.0%),partial occlusion in 7VDAs (10.3%).Procedure-related complications occurred in 3 patients (10.7%) in LVIS stent group and 3 patients (4.4%) in Enterprise stent group.DSA follow-up was performed during 6 to 12 months after surgery,and 10 patients with vertebral artery dissection aneurysm recurred,2 in the LVIS group and 8 in the Enterprise stent group.The latest modified Rankin Scale score was 0 in 55 patients,1 in 13,2 in 1,3 in 1,and 6 in 1.Among them,all follow-up patients in the LVIS stent group had good prognosis,while in the Enterprise stent group,50 patients (94.4%) had a good prognosis.Conclusions The stent-assisted coils have a higher degree of embolization in the vertebral artery dissection aneurysms,a higher rate of near-total embolization,a lower incidence of neurological complications,and a good prognosis.The complete andnear-complete occlusion rates and the incidence of neurological complicationsin the LVIS group was higher than that in the Enterprise groupand the recurrence ratesin the LVIS group was lower than that in the Enterprise group,both with no statistically significant difference.