支架辅助弹簧圈栓塞治疗大脑中动脉分叉部宽颈动脉瘤

Stent-assisted coil embolization of wide-necked middle cerebral artery bifurcation aneurysms

目的 观察支架辅助弹簧圈栓塞治疗大脑中动脉分叉部宽颈动脉瘤的安全性和有效性。方法 分析60例接受支架辅助弹簧圈栓塞治疗的大脑中动脉分叉部宽颈动脉瘤患者共65个动脉瘤,观察术后即刻及随访动脉瘤栓塞程度,评估术后并发症、疗效及安全性。结果 术中2例(2/60,3.33%)动脉瘤破裂出血,4例(4/60,6.67%)支架内血栓形成;术后即刻栓塞程度为RaymondⅠ级50个(50/65,76.92%)、Ⅱ级12个(12/65,18.46%)、Ⅲ级3个(3/65,4.62%)。术后1个月内3例(3/60,5.00%)动脉瘤再出血,2例致死;1例(1/60,1.67%)死于肺栓塞;4例(4/60,6.67%)并发脑梗死。1例术后6个月瘤颈复发,1例术后25个月出现无症状性血管闭塞;末次复查数字减影血管造影显示43个(43/51,84.31%)RaymondⅠ级、8个(8/51,15.69%)Ⅱ级。末次随访,49例(49/57,85.96%)改良Rankin量表评分为0~2分,8例(8/57,14.04%)为3~4分。结论 支架辅助弹簧圈栓塞技术治疗大脑中动脉宽颈动脉瘤安全、有效。

Objective To observe the safety and efficacy of stent-assisted coil embolization of wide-necked middle cerebral artery bifurcation aneurysms. Methods Totally 60 patients with 65 middle cerebral artery bifurcation aneurysms who underwent stent-assisted coil embolization were analyzed. The immediate and follow-up embolization degree of aneurysms, the postoperative complications, curative effect and safety were evaluated. Results Aneurysm bleeding occurred in 2 cases(2/60, 3.33%), while in-stent thrombi formed in 4 cases(4/60, 6.67%) during embolization. Immediately after embolization, the degree of aneurysm occlusion was Raymond grade Ⅰ in 50 aneurysms(50/65, 76.92%), grade Ⅱ in 12 aneurysms(12/65, 18.46%) and grade Ⅲ in 3 aneurysms(3/65, 4.62%). For the first month after embolization, aneurysm re-bleeding occurred in 3 cases(3/60, 5.00%) and caused death of 2 cases among them, one patient(1/60, 1.67%) died of pulmonary embolism, while cerebral infarction occurred in 4 cases(4/60, 6.67%). Aneurysm recurred 6 months after embolization in 1 case, and asymptomatic vascular occlusion developed in 1 case 25 months after embolization. The last time digital subtraction angiography showed that the occlusion degree of 43 aneurysms(43/51, 84.31%) were Raymond grade Ⅰ, of 8 aneurysms(8/51, 15.69%) were grade Ⅱ. At the end of following up, the modified Rankin scale(mRS) scores of 49 cases(49/57, 85.96%) ranged from 0 to 2, and of 8 cases(8/57, 14.04%) ranged from 3 to 4. Conclusion Stent-assisted coil embolization was effective and safe for treating wide-necked middle cerebral artery bifurcation aneurysms.