LEO Baby支架在颅内远端小血管破裂动脉瘤中的应用

Application of LEO Baby stent in distal ruptured intracranial aneurysms in small artery

目的探讨LEO Baby支架辅助弹簧圈栓塞治疗颅内远端小血管破裂动脉瘤的安全性及有效性。方法回顾性分析2019年1月至2021年6月在晋城市人民医院神经外科使用LEO Baby支架辅助栓塞治疗的27例颅内远端小血管破裂动脉瘤的临床资料。27例动脉瘤均为宽颈破裂动脉瘤,所有患者均采用单支架辅助栓塞及支架半释放技术,围术期使用替罗非班行抗血小板治疗。采用Raymond分级评价患者术后即刻栓塞效果和术后半年动脉瘤的愈合情况;采用改良的Rankin量表(mRS)评分评价患者术后半年的神经功能恢复情况,其中mRS评分≤2分者为预后良好,mRS评分>2分者为预后不良。结果27例患者支架均成功释放,技术成功率为100%。术后即刻数字减影血管造影(DSA)示:RaymondⅠ级21例(77.8%),RaymondⅡ级4例(14.8%),RaymondⅢ级2例(7.4%)。围术期缺血事件3例(11.1%),无出血事件发生。术后半年复查,DSA示:RaymondⅠ级23例(85.2%),RaymondⅡ级2例(7.4%),RaymondⅢ级1例(3.7%),复发1例。所有患者均未见血管狭窄和支架内血栓形成等事件的发生。术后半年神经功能恢复情况评分示,预后良好25例(92.6%)。结论LEO Baby支架用于颅内远端小血管破裂动脉瘤的治疗安全、有效,且具有一定的血流导向作用。

Objective To evaluate the safety and efficacy of LEO Baby stent-assisted coiling in the treatment of distal ruptured intracranial aneurysms in small artery.Methods The clinical data of 27 cases with ruptured aneurysms of distal intracranial small artery and treated with LEO Baby stent were analyzed retrospectively,all of whom were admitted in the Department of Neurosurgery of Jincheng People's Hospital from January 2019 to June 2021.All 27 aneurysms were wide necked ruptured aneurysms,and were treated with single stent-assisted embolization and stent semi-release technology.All patients were treated with Tirofiban during perioperative period.Raymond grading was used to evaluate the immediate effect and aneurysm healing half a year after operation;modified Rankin scale(mRS)score was used to evaluate the recovery of neurological function half a year after operation.Those with mRS score≤2 had a good prognosis,and those with mRS score>2 had a poor prognosis.Results The stent was successfully released in 27 patients,and the technical success rate was 100%.Immediate postoperative angiography showed that 21 cases(77.8%)were Raymond gradeⅠ,4 cases(14.8%)were Raymond gradeⅡ,and 2 cases(7.4%)were Raymond gradeⅢ.Perioperative ischemic events occurred in 3 cases(11.1%),and no bleeding occurred.Six months after operation,27 patients underwent cerebral angiography.There were 23 cases of RaymondⅠ(85.2%),2 RaymondⅡ(7.4%),1 RaymondⅢ(3.7%),and 1 recurrence.No vascular stenosis and stent thrombosis occurred in all patients.The neurological recovery score of 27 patients half a year after operation showed that 25 cases(92.6%)had a good prognosis.Conclusion LEO Baby stent is safe and effective in the treatment for distal ruptured intracranial aneurysms in small artery,and has a certain blood flow guiding effect.