Tubridge血流导向装置治疗颅内大型未破动脉瘤

Safety and efficacy of Tubridge flow-diverter devices for patients with large unruptured intracranial aneurysm(report of 8 cases)

目的探讨Tubridge血流导向装置(TFD)治疗颅内大型未破动脉瘤的安全性和疗效。方法回顾性分析2018年7月至2019年7月采用TFD治疗的8例颅内大型未破动脉瘤的临床资料,其中3例采用单纯TFD治疗,5例采用TFD+弹簧圈栓塞治疗。结果8例共8个动脉瘤,共置入Tubridge支架8枚,其中7枚支架均成功置入并打开良好;1枚支架术中部分打开不良,经微导丝按摩后完全打开;支架置入成功率为100%。5例TFD+弹簧圈栓塞治疗术后即刻造影显示Raymond分级Ⅲ级2例,Ⅱ级3例;3例采用单纯TFD置入术后即刻造影显示动脉瘤瘤腔内造影剂明显滞留。术后即刻造影显示脉络膜前动脉、后交通动脉及眼动脉等分支动脉显影通畅,未见明显狭窄。术后复查DSA及颅脑CT未见出血及缺血事件。8例门诊随访6~24个月,4例症状完全消失,3例明显改善,1例体检发现病人手术前后均无症状。5例DSA随访6~12个月,动脉瘤均不显影(Raymond分级Ⅰ级,其中TFD+弹簧圈治疗3例,单纯TFD治疗2例)。结论TFD治疗颅内大型未破动脉瘤安全性高,短期疗效满意,长期疗效有待进一步研究。

Objective To explore the safety and efficacy of Tubridge flow-diverter devices(TFD)for the patients with large unruptured intracranial aneurysm.Methods The clinical data of 8 patients with large unruptured intracranial aneurysm,of whom 5 were treated with TFD and coil embolization and 3 with simple TFD,from July 2018 to July 2019 were analyzed retrospectively.Results These 8 patients with 8 aneurysms received 8 Tubridge stents which were successfully implanted.Immediate angiography after TFD+coil embolization in 5 patients showed Raymond gradeⅢin 2 patients and gradeⅡin 3.Immediate angiography after simple TFD implantation in 3 patients showed significant retention of contrast agent in the aneurysms.Immediate postoperative angiography showed that the branch arteries such as the anterior choroidal artery,posterior communicating artery,and ophthalmic artery were patency without obvious stenosis in all the patients.There were no bleeding and ischemic events after the operation.The outpatient follow up(6~24 months)of these 8 patients showed complete disappearance of symptoms in 4 patients,marked improvement in 3,and no symptom before and after the operation in 1.The DSA follow-up(6~12 months)of 5 patients showed Raymond gradeⅠin 5 patients,including 3 patients treated with TFD+coil embolization and 2 with simple TFD.Conclusion For large unruptured intracranial aneurysms,TFD is safe and its short outcomes are good,but its long-term effectiveness needs further follow-up.