颈内动脉多发宽颈动脉瘤的介入治疗分析

Analysis of stent-assisted intervenient treatment of multiple wide-necked aneurysms of internal carotid arteries

目的探讨颈内动脉多发宽颈动脉瘤的介入治疗方法及临床效果。方法回顾性分析2016年5月至2018年12月介入治疗的32例(67枚)颈内动脉多发宽颈动脉瘤的临床资料。微导管穿支架网眼进入动脉瘤腔栓塞11例;微导管先置入动脉瘤腔后释放支架进行栓塞12例;支架半释放法栓塞4例;密网支架置入覆盖动脉瘤颈5例。67枚动脉瘤中,55枚采用支架辅助栓塞;1枚在处理临近眼动脉段动脉瘤时以支架覆盖;11枚行密网支架覆盖瘤颈。结果术后即时造影证实支架辅助栓塞55枚中,Raymond分级Ⅰ级49枚,Ⅱ级6枚;5例11枚动脉瘤行密网支架治疗,术后即时造影均显示动脉瘤内血流减缓,造影剂滞留。术中出现动脉瘤破裂出血1例,部分弹簧圈突出于支架内1例,支架置入后打开不全2例。30例共63枚动脉瘤进行3~6个月(平均3.4个月)造影随访;49枚完全栓塞的动脉瘤中,46枚没有变化,3枚瘤颈区少量显影。6枚近全栓塞动脉瘤中,3枚转为完全栓塞,3枚没变化;1枚仅支架覆盖的眼动脉段小动脉瘤形态无变化;3例共7枚动脉瘤行密网支架治疗,复查造影显示瘤体显影减小,造影剂明显滞留;2例共4枚动脉瘤密网支架置入术治疗后尚未复查。30例术后临床随访3~6个月,改良Rankin量表评分0分23例,1分5例,2分2例;预后良好率为93.33%(28/30)。结论根据载瘤血管及多发动脉瘤具体情况,采用多种支架辅助栓塞治疗颈内动脉多发宽颈动脉瘤,近期随访均可取得较高的动脉瘤栓塞率及较好的临床预后。

Objective To explore the technique and clinical outcomes of stent-assisted coils endovascular embolization of themultiple wide-necked aneurysms (MWNA) of the internal carotid arteries (ICA). Methods Thirty-two patients with 67 ICA MWNA weretreated by stent-assisted coils endovascular embolization in our department from May, 2016 to December, 2018.The embolization effectswere assessed by Raymond grading . DSA was performed again in 30 patients 3 or 6 months after the therapy, when modified Rankinscale score (mRS) was used to evaluate the clinical effects. Results DSA showed immediately after the treatment that of 67 aneurysms,49 received Raymond grade Ⅰ occlusion (complete occlusion), 6 Raymond grade Ⅱ (subtotal occlusion ), 1 was covered with oneordinary stent and 11 received the covering of the aneurismal necks with dense mesh stents . The prognosis belonged in mRS 0 point in23, mRS 1 point in 5 and mRS 2 points in 2 of 30 patients followed up 3 or 6 months after the treatment. The patients withoutneurological function disturbance accounted for 93.33% (30/32) of all the patients followed up. DSA 3 or 6 months after the embolizationshowed that no MWNA recurred in all the patients and the cavities of all aneurysms reduced in 3 patients treated with dense mesh stents.Conclusion The short-term curative effects of stent-assisted coil endovascular embolization on MWNA are good.