LVIS支架辅助栓塞颈内动脉床突上段破裂夹层动脉瘤

LVIS stent assisted coils embolization for ruptured dissecting aneurysms in the internal carotid artery supraclinoid segment

目的探讨LVIS支架辅助栓塞治疗颈内动脉床突上段破裂夹层动脉瘤的可行性、有效性。方法回顾性分析2015年6月到2018年3月采用LVIS支架辅助栓塞治疗的9例颈内动脉床突上段破裂夹层动脉瘤的临床资料。结果9例均成功实施LVIS支架辅助栓塞治疗,术后即刻造影显示Raymond分级Ⅰ级5例,Ⅱ级4例。术后DSA随访1周~24个月,2例双LVIS支架辅助栓塞术后2周DSA复查显示动脉瘤复发,血栓弹力图示ADP>90%,调整抗血小板方案后半年后复查动脉瘤未显影;其余病人动脉瘤均未显影,载瘤动脉通畅。出院时改良Rankin量表(mRS)评分0分5例,3分2例,4分1例,6分1例;术后90 d mRS评分0分6例,1分1例,3分1例。结论LVIS支架辅助栓塞颈内动脉床突段破裂夹层动脉瘤是一种安全、有效的方法,调整抗血小板方案可提高术后复发动脉瘤的闭塞率。

Objective To explore the feasibility and effectiveness of LVIS stent assisted coils embolization for the dissecting aneurysms in the internal carotid artery supraclinoid segment.Methods The clinical data of 9 patients with dissecting aneurysms in in the internal carotid artery supraclinoid segment who were treated by LVIS stent assisted coils embolization from June,2015 to March,2018,were analyzed retrospectively.Results These 9 patients were successfully treated with LVIS stent assisted coils embolization.DSA immediately after the embolization showed Raymond gradeⅠin 5 patients,and gradeⅡin 4.The follow-up of DSA ranging from 1 weeks to 24 months after the operation showed that the aneurysms recurred in 2 patients who were treated by double LVIS stent-assisted embolization 2 weeks after the operation,and the aneurysms were disapperaed 6 months after adjusting the antiplatelet regimen.On the discharge,the modified Rankin scale(mRS)scores were 0 point in 5 patients,3 points in 2,4 points in 1,and 6 points in 1.Ninty days after the operation,the mRS scores were 0 point in 6 patients,1 point in 1 and 3 points in 1.Conclusions LVIS stent assisted coils embolization is a safe and effective method for the treatment of ruptured dissecting aneurysm in the internal carotid artery supraclinoid segment.The occlusive rate of recurrent aneurysms can be increased by adjusting antiplatelet regimen.