Willis覆膜支架急诊重建修复医源性颈内动脉破裂3例

Emergency reconstruction of iatrogenic internal carotid rupture with Willis covered stent implantation:preliminary experience in 3 cases

目的探讨Willis覆膜支架急诊重建修复医源性颈内动脉破裂的有效性和安全性。方法回顾性分析2018年1月至2019年12月河南省人民医院采用Willis覆膜支架治疗的3例医源性颈内动脉破裂患者临床资料。3例患者均为女性,年龄48~58岁,均为鼻内镜手术中损伤颈内动脉致破裂出血。结果 2例垂体腺瘤患者、1例视神经损伤患者在分别行经鼻内镜鞍区占位切除术、视神经管减压术中发生颈内动脉损伤破裂出血。给予压迫止血后转入复合手术室,行Willis覆膜支架重建修复术。颈内动脉破口均成功修复,无颈内动脉闭塞或狭窄并发症发生,患者治愈出院。结论 Willis覆膜支架可及时、安全有效地重建修复医源性颈内动脉破裂。但仍需积累更多资料评估中远期疗效。

Objective To investigate the efficacy and safety of Willis covered stent implantation in emergency reconstruction of iatrogenic internal carotid rupture. Methods The clinical data of 3 patients with iatrogenic internal carotid rupture, who were admitted to the Henan Provincial People’s Hospital of China during the period from January 2018 to December 2019 to receive Willis covered stent implantation, were retrospectively analyzed. All the three patients were females, aged 48-58 years. The internal carotid rupture with bleeding was caused by surgical injury during transnasal endoscopy operation in all 3 patients. Results In 3 patients, the primary diseases included pituitary adenoma(n=2) and optic nerve injury(n=1). Transnasal endoscopy surgery, including resection of sellar space-occupying lesion and decompression of optic canal,was carried out for each patient, and during the operation the internal carotid was injured, and internal carotid rupture with bleeding occurred. After hemostasis by compression, the patients were transferred to the hybrid operating room to receive Willis covered stent implantation for emergency reconstruction of internal carotid. Successful repair of internal carotid rupture was achieved in all 3 patients. No occlusion or stenosis of internal carotid occurred. The patients were cured and discharged. Conclusion Willis covered stent implantation can promptly, safely and effectively repair and reconstruct the iatrogenic internal carotid rupture,but more researches need to be conducted before its mid-to-long-term effect can be clarified.