Willis覆膜支架在大型或巨大型床突旁动脉瘤血管内重建治疗中的初步应用

Preliminary application of the Willis covered stent in endovascular reconstruction for the treatment of large or giant paraclinoid aneurysm

目的探讨Willis覆膜支架(WCS)治疗大型或巨大型床突旁动脉瘤的安全性和有效性。方法回顾性分析2014年12月至2018年11月陆军军医大学大坪医院神经外科收治的17例大型或巨大型床突旁动脉瘤患者(共17个动脉瘤)的临床资料。其中9例为破裂动脉瘤,Hunt-Hess分级Ⅱ级7例,Ⅲ级2例。动脉瘤最大径为(18±5)mm(11~28 mm),其中大型动脉瘤15个,巨大型动脉瘤2个;瘤颈宽度>4 mm的动脉瘤12个。所有患者均一期行WCS置入血管内重建治疗。术后对所有患者进行临床随访,复查数字减影血管造影(DSA)明确动脉瘤有无残留、复发以及载瘤动脉通畅情况;采用改良Rankin量表评分(mRS)评估患者的神经功能恢复情况。结果17例患者共成功置入18枚WCS。无一例出现治疗相关的急性并发症,如术中动脉瘤破裂、支架移位或塌陷、急性血栓形成等。WCS置入后的即刻DSA显示,3例对比剂轻微内漏进入动脉瘤腔,其中2例经球囊扩张内漏基本消失,1例仍残留轻微内漏;另14例动脉瘤完全闭塞、载瘤动脉血流通畅。17例患者中,10例患者眼动脉闭塞未显影,但均无相关临床症状。所有患者术后即刻和出院时头颅CT平扫均未见出血或缺血表现。17例患者的中位随访时间为18个月(6~30个月),复查DSA发现1例Ⅲb型内漏(术后第14个月),予再次手术套叠1枚WCS治愈。末次随访时,所有患者的动脉瘤均完全闭塞、未见复发;mRS 0分13例,1分4例。结论初步观察发现,应用WCS血管内重建治疗大型或巨大型床突旁动脉瘤较为安全、短期疗效较好。

Objective To explore the safety and effectiveness of the Willis covered stent(WCS)in the treatment of large or giant paraclinoid aneurysms.Methods We retrospectively reviewed the clinical data of 17 patients with 17 large and giant paraclinoid aneurysms who were admitted to Department of Neurosurgery,Daping Hospital,Army Medical University between December 2014 and November 2018.Among them,there were 7 cases of Hunt-Hess gradeⅡ,and 2 cases of gradeⅢ.The maximal diameter of aneurysms was 18±5 mm(11-28 mm),including 15 large aneurysms and 2 giant aneurysms.There were 12 aneurysms with the neck width of>4 mm.All patients underwent phase-Ⅰendovascular reconstruction with WCS implantation.Postoperative follow-up was performed for all patients.Digital subtraction angiography(DSA)was used to confirm whether the aneurysms had residual or recurrence and assess the patency of the parent artery.Modified Rankin scale(mRS)was used to evaluate the neurological recovery of the patients.Results A total of 18 WCS were deployed in 17 patients.No treatment-related acute complications such as intraoperative aneurysm rupture,displacement or collapse of the stent,acute thrombosis occurred in this series.Immediate post-procedural angiography revealed mild endoleak into the aneurysm sac in 3 cases,which almost disappeared in 2 cases after balloon dilatation and remained in 1 case.The other 14 patients showed complete aneurysm occlusion and patent parent artery.Among the 17 patients,occlusion of the ophthalmic artery was revealed in 10 patients who did not develop related clinical symptoms.The head CT scan immediately post procedure and at discharge did not show any evidence of bleeding or ischemia.The median follow-up time of 17 patients was 18 months(6-30 months).The DSA at 14-month follow-up showed the typeⅢb endoleak in 1 case,which resolved by a second operation of stacking another WCS.At the last follow-up,aneurysms of all patients were completely occluded and no recurrence was observed.The mRS score at follow-up was 0 in 13 patients and 1 in 4 patients.Conclusion Preliminary observation suggests that endovascular reconstruction with WCS for the treatment of large or giant paraclinoid aneurysms seems relatively safe with good short-term therapeutic effect.