LVIS支架辅助弹簧圈栓塞治疗颈内动脉床突上段夹层动脉瘤

Efficacy and safety of LVIS stent-assisted coil embolization for dissecting aneurysms of the supraclinoid internal carotid artery

目的 探讨LVIS支架辅助弹簧圈栓塞治疗颈内动脉床突上段夹层动脉瘤(DA-SICA)的可行性、有效性。方法 回顾性分析2015年1月至2020年7月运用LVIS支架辅助弹簧圈栓塞治疗的28例DA-SICA的临床资料。结果 双LVIS支架辅助栓塞13例,术后即刻造影显示Raymond分级Ⅰ级10例,Ⅱ级3例;单LVIS支架辅助栓塞15例,术后即刻造影显示均为Raymond分级Ⅰ级。术中动脉瘤破裂出血2例。围手术期死亡3例,其中2例死于恶性脑肿胀,1例死于再出血。存活25例术后随访3~49个月,平均(26.5±2.5)个月;2例术后复发,再次使用LVIS支架辅助弹簧圈栓塞治愈;其余23例术后3个月复查DSA无动脉瘤复发及载流动脉狭窄。结论 LVIS支架辅助弹簧圈栓塞治疗DA-SICA,是一种有效、可行的选择,使用支架的数目应根据术中具体情况决定,术后应制定个体化的抗血小板治疗方案。

Objective To evaluate the feasibility and effectiveness of LVIS stent-assisted coil embolization for dissecting aneurysms of the supraclinoid internal carotid artery(DA-SICA).Methods The clinical data of 28 patients with DA-SICA who were treated by LVIS stents assisted coil embolization from January 2015 to July 2020 were analyzed retrospectively.Results Of 13 patient undergoing double LVIS stents assisted coils embolization,immediate postoperative angiography showed Raymond grade Ⅰ in 10patients and grade Ⅱ in 3.Of 15 patients undergoing single LIVS stent assisted coils embolization,immediate postoperative angiography showed Raymond grade Ⅰ in all the 15 patients.Intraoperative re-bleeding occurred in 2 patients.Three patients died during the perioperative period.The follow up of 25 survivals(range,3~49 months;mean,26.5±2.5 months) showed aneurysm recurrence in 2patients who were cured by single LVIS stent assisted embolization.The DSA of the other 23 sirvivals showed no aneurysm recurrence and no stenosis of parent artery.Conclusions LVIS stents assisted coil embolization is a feasible and effective option for the patients with DA-SICA.The number of stents to be used should be determined according to the specific situation during the operation,and an individualized antiplatelet treatment should be performed on the patients after embolization.