Willis覆膜支架治疗颈内动脉颅内段创伤性假性动脉瘤的疗效分析

Clinical study of Willis covered stent in the treatment of traumatic pseudoaneurysm of intracranial segment of internal carotid artery

目的探讨Willis覆膜支架治疗颈内动脉颅内段创伤性假性动脉瘤的安全性和有效性。方法回顾性分析2013年12月至2019年5月中国人民解放军中部战区总医院神经外科收治的15例颈内动脉颅内段创伤性假性动脉瘤患者的临床资料。术中根据载瘤动脉的直径和累及病变血管的长度选择合适尺寸的Willis覆膜支架。术后对所有患者常规行头颅Dyna-CT复查和支架重建。出院后对所有患者行门诊随访,随访内容包括复查头颅数字减影血管造影(DSA),以判断动脉瘤是否复发;同时行改良Rankin量表(mRS)评分,以判断患者预后。结果15例患者中,12例均一次性成功置入Willis覆膜支架;另3例置入Willis覆膜支架后存在"内漏",其中1例行1次球囊扩张后"内漏"消失,2例术后连续1~2个月辅助压迫病变侧颈动脉。术后即刻DSA显示,所有患者的血管重建成功,假性动脉瘤均消失。术后1例患者因重型颅脑创伤死亡,其余14例术后复查Dyna-CT均未见新发脑梗死和脑出血。所有患者均无手术相关并发症。14例患者的随访时间为(5.4±1.6)个月(3.0~8.0个月)。术后3个月,14例患者的mRS评分为,1~2分10例,3分4例。随访期间,12例患者获得DSA随访,至末次随访均未复发,其中2例存在"内漏"的患者于术后4个月随访时"内漏"消失。结论初步推测Willis覆膜支架治疗颈内动脉颅内段创伤性假性动脉瘤是安全、有效的;可能是理想材料之一。

Objective To investigate the safety and efficacy of Willis covered stent(WCS)in the treatment of traumatic pseudoaneurysm of intracranial segment of internal carotid artery(ICA).Methods A retrospective study was conducted on the clinical data of 15 patients with traumatic pseudoaneurysm of intracranial segment of ICA who were admitted to Department of Neurosurgery,General Hospital of PLA Central Theater Command from December 2013 to May 2019.WCS was selected based on the diameter of the parent artery and length of the involved vessels.Postoperative Dyna-CT reexamination and stent reconstruction were performed routinely in all patients.All patients were followed up after discharge and digital subtraction angiography(DSA)reexamination was performed to determine the recurrence of aneurysm.MRS(modified Rankin scale)score was also performed to assess the patient′s recovery.Results Among the 15 patients,12 were successfully implanted with WCS at one time and the remaining 3 had"internal leakage"after WCS implantation.Among the 3 cases,1 underwent balloon dilation and the"internal leakage"disappeared,and the remaining 2 underwent postoperative auxiliary compression on the ipsilateral carotid artery.Immediately after the operation,DSA showed that all patients had successful vascular reconstruction and pseudoaneurysms disappeared.One patient died of severe craniocerebral trauma after surgery,while the other 14 patients had no new cerebral infarction or cerebral hemorrhage revealed by postoperative Dyna-CT.No surgical-related complications occurred in this series.The follow-up duration of 14 patients was 5.4±1.6 months(3.0-8.0 months).At 3 months post operation,the mRS scores of 14 patients were 1-2 points in 10 cases and 3 points in 4.The aneurysms of 12 patients were followed up with DSA,and no recurrence was discovered at the last follow-up,Two patients of"internal leakage"were followed up at 4 months after operation,the"internal leakage"disappeared.Conclusion WCS seems safe and effective in the treatment of traumatic pseudoaneurysms in the intracranial segment of ICA and may be one of the ideal materials for that treatment.