经桡动脉入路Simmons2导管同轴技术在颅内未破裂动脉瘤栓塞术中的应用

Application of Simmons 2 catheter coaxial technique with transradial acess in the embolization of intracranial unruptured aneurysms

目的探讨经桡动脉入路(TRA)栓塞颅内未破裂动脉瘤术中应用Simmons 2( SIM2)导管同轴技术的可行性及安全性。方法回顾性分析南京医科大学第一附属医院神经外科于2021年5-7月采用血管内栓塞治疗的32例(37个动脉瘤)颅内未破裂动脉瘤患者的临床资料, 所有患者均采用SIM2(125 cm)导管同轴技术经桡动脉入路建立手术通道。其中目标血管包括右侧颈内动脉21处, 左侧颈内动脉11处, 右侧椎动脉3处, 左侧椎动脉2处;Myla分型Ⅰ型主动脉弓10例、Ⅱ型17例、Ⅲ型5例。总结分析手术通路建立的成功率、手术相关并发症及动脉瘤的治疗情况。结果 32例患者的37个动脉瘤均成功建立手术通道并完成栓塞治疗。术中无一例患者发生同轴导管系统疝入主动脉弓、动脉瘤破裂、急性血栓形成或血栓栓塞事件。37个动脉瘤术后即刻评估, 改良Raymond分级Ⅰ级栓塞17个、Ⅱ级14个、Ⅲa级6个。术后第3天1例患者头颅CT显示右侧颞叶出血灶, 给予药物治疗。术后3~6个月随访, 32例患者行改良Rankin量表评分评估, 其中0分29例, 1分3例;23例患者的25个动脉瘤行数字减影血管造影随访, 其中改良Raymond分级Ⅰ级栓塞21个、Ⅱ级4个, 均未见动脉瘤复发。结论 TRA栓塞颅内未破裂动脉瘤术中采用SIM2导管同轴技术建立手术通道的技术成功率高、相关并发症发生率低。

ObjectiveTo investigate the feasibility and safety of Simmons 2(SIM2)catheter coaxial technology with transradial access(TRA)in the embolization of intracranial unruptured aneurysms.MethodsA retrospective analysis was performed on the clinical data of 32 patients with 37 intracranial unruptured aneurysms treated with endovascular embolization from May to July 2021 at the Department of Neurosurgery,the First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital).All patients underwent the SIM2(125 cm)catheter coaxial technology to establish surgical channels with TRA.Among them,the target blood vessels included 21 right internal carotid artery,11 left internal carotid artery,3 right vertebral artery,and 2 left vertebral artery.There were 10 cases of typeⅠaortic arch,17 cases of typeⅡ,and 5 cases of typeⅢ.The success rate of surgical channel establishment,surgery-related complications and aneurysm treatment were summarized and analyzed.Results All 32 patients(37 aneurysms)successfully underwent surgical channel establishment and embolization therapy.None of the patients during surgery developed a herniation of the coaxial catheter system into the aortic arch,rupture of the aneurysm,acute thrombosis,or thromboembolic events.Immediately after surgery,there were 17 cases of gradeⅠ,14 cases of gradeⅡ,and 6 cases of gradeⅢa according to the modified Raymond classification system.On the third postoperative day,one patient showed a right temporal lobe hemorrhage on head CT and was given drug treatment.At the follow-up of 3-6 months after surgery,32 patients underwent assessment using the modified Rankin scale and there were 29 cases of score 0 and 3 cases of score 1.A total of 25 aneurysms of 23 patients underwent DSA,which demonstrated modified Raymond gradeⅠin 21 cases and gradeⅡin 4 cases,and no aneurysm recurrence was identified.Conclusions The use of SIM2(125 cm)catheter coaxial technology to establish surgical channel with TRA for the embolization of intracranial unruptured aneurysms has a high success rate and few associated complications,which is suitable for intracranial aneurysm embolization.