LVIS支架辅助弹簧圈栓塞在颅内宽颈破裂动脉瘤治疗中的应用

Application of LVIS stent assisted coil embolization in the treatment of intracranial wide neck ruptured aneurysms

目的分析低剖面可视化腔内支撑装置(LVIS)支架辅助弹簧圈栓塞在颅内宽颈破裂动脉瘤治疗应用中的安全性和有效性。方法回顾性分析南昌大学第二附属医院神经外科自2016年7月至2017年7月收治的行LVIS支架辅助弹簧圈栓塞治疗的43例颅内宽颈破裂动脉瘤伴蛛网膜下腔出血患者。采用改良Raymond分级标准评价术后即刻的栓塞结果以及术后6个月第1次的动脉瘤随访闭塞程度;采用改良Rankin评分(mRs)评估患者预后疗效情况。结果43例颅内宽颈破裂动脉瘤伴蛛网膜下腔出血患者动脉瘤共47枚,其中2例(4.6%)患者为多发动脉瘤,均成功栓塞。43例动脉瘤患者中1例(2.3%)出现术中动脉瘤破裂出血,2例(4.6%)术中出现支架内急性血栓;术后即刻闭塞情况:Ⅰ级栓塞35例(81.4%),Ⅱ级6例(13.9%),Ⅲ级2例(4.7%);术后6个月随访结果:Ⅰ级栓塞40例(93.0%),Ⅱ级2例(7.0%),1例(2.3%)复发,后期予再栓塞治疗;术后1年mRs评分为0~2分有41例(95.3%)。结论LVIS支架辅助下栓塞颅内宽颈破裂动脉瘤是安全、有效的治疗方法,但长期疗效仍需要进一步验证。

Objective Analyze the safety and effectiveness of low-profile visualized intraluminal support(LVIS)stent-assisted coil embolization in the treatment of intracranial wide neck ruptured aneurysms.Methods Forty-three patients with subarachnoid hemorrhage caused by wide neck ruptured aneurysm treated with LVIS stent-assisted coil embolization in the Department of Neurosurgery,the Second Affiliated Hospital of Nanchang University from July 2016 to July 2017 were analyzed retrospectively.The modified Raymond classification standard was used to evaluate the embolization results and the degree of occlusion of the most recent aneurysm immediately after surgery and 6 months after surgery.The modified Rankin score(mRs)was used to evaluate the postoperative efficacy of the patients.Results There were 47 aneurysms in 43 patients with intracranial wide neck ruptured aneurysms and subarachnoid hemorrhage,2(4.6%)patients were multiple aneurysms,all of which were successfully embolized.In 43 patients with aneurysms,1(2.3%)had ruptured aneurysm and bleeding during operation,and 2(4.6%)had acute thrombus in stent during operation;immediate occlusion after operation:35(81.4%)patients with gradeⅠembolization,6(13.9%)patients with gradeⅡembolization,and 2(4.7%)patients with gradeⅢembolization;6-month follow-up results:40(93.0%)patients with gradeⅠembolization,2(7.0%)patients with gradeⅡembolization,1(2.3%)had relapse,and they were re-embolized later 41(95.3%)cases had mRs score of 0-2 in 1 year after operation.Conclusion LVIS stent-assisted coil embolization is a safe and effective treatment for intracranial wide-neck ruptured aneurysms.Further long term follow-up studies will be necessary to confirm its long-term efficacy.