支架治疗颅内远端动脉瘤安全性和有效性分析

Stenting for intracranial distal aneurysms: analysis of its safety and efficacy

目的 探讨血管内支架治疗颅内远端动脉瘤的安全性和有效性。方法 回顾性分析2018年1月至2021年12月在河南省人民医院接受血管内支架治疗的40例颅内远端动脉瘤患者临床资料,动脉瘤共43枚。动脉瘤辅助支架栓塞治疗32例(34枚),血流导向装置治疗8例(9枚)。颅内远端动脉瘤定义为位于前循环中A2/M2段、后循环中P2段及其远端动脉瘤。随访期采用Raymond分级评分评估动脉瘤栓塞情况,改良Rankin量表(mRS)评分评估临床预后。结果 34枚动脉瘤成功完成支架辅助弹簧圈栓塞治疗,末次影像随访结果显示31枚(91.2%)动脉瘤Raymond评分Ⅰ级,3枚Ⅱ级。4例(12.5%)患者发生手术相关缺血性并发症。中位随访6.5个月,31例(96.9%)患者mRS评分为0~2分,获得良好预后。9枚动脉瘤成功完成血流导向装置治疗,末次影像随访结果显示5枚动脉瘤Raymond分级Ⅰ级,3枚Ⅱ级,1枚失访。1例患者发生缺血性并发症。中位随访9个月,6例患者mRS评分为0~2分,获得良好预后。结论 血管内支架辅助栓塞颅内远端动脉瘤是一种安全有效的治疗策略。小口径支架应用提高了颅内远端动脉瘤治疗闭塞率,血流导向装置是用传统方法治疗具有挑战性的远端动脉瘤的有效替代方法。

Objective To discuss the safety and efficacy of endovascular stent implantation in the treatment of intracranial distal aneurysms. Methods The clinical data of 40 patients with intracranial distal aneurysm(43 aneurysms in total), who were admitted to the Henan Provincial People’s Hospital of China to receive endovascular stent implantation therapy between January 2020 and December 2021, were retrospectively analyzed. Stent-assisted spring coil embolization therapy of aneurysm was adopted in 32 patients(34 aneurysms in total), and flow diverter device was employed in 8 patients(9 aneurysms in total). Intracranial distal aneurysm was defined as an aneurysm that was located at the A2/M2 segment of the anterior circulation, or at the P2segment of the posterior circulation and its distal end. During the follow-up period, the aneurysm embolization condition was assessed by Raymond grade score, and the clinical outcome was evaluated by modified Rankin scale(m RS) score. Results Successful stent-assisted spring coil embolization was accomplished for 34 aneurysms.The last follow-up angiography showed that Raymond score of grade Ⅰ was obtained in 31 aneurysms(31/34,91.2%) and grade Ⅱ in 3 aneurysms. Four patients(12.5%) developed surgery-related ischemic complications.The patients were followed up for a median time of 6.5 months, and 31 patients(96.9%) had an mRS score of0-2 points and achieved a good prognosis. Successful flow diverter device treatment was accomplished for 9aneurysms. The last follow-up angiography revealed that Raymond score of grade Ⅰ was obtained in 5 aneurysms and grade Ⅱ in 3 aneurysms, and one patient was lost in touch. One patient developed ischemic complication.The median follow-up time was 6.5 months, and 6 patients had an mRS score of 0-2 points and achieved a good prognosis. Conclusion For intracranial distal aneurysms, endovascular stent-assisted spring coil embolization is a safe and effective treatment. The application of small-caliber stent can improve the occlusion rate of intracranial distal aneurysms, while the use of flow diverter device is an effective alternative to traditional treatment.(J Intervent Radiol, 2022, 31: 1146-1150)