Neuroform Atlas支架辅助弹簧圈栓塞大脑中动脉分叉部动脉瘤的疗效观察

Efficacy of Neuroform Atlas stent-assisted coil embolization for treatment of aneurysm at middle cerebral artery bifurcation

目的观察Neuroform Atlas支架辅助弹簧圈栓塞大脑中动脉(MCA)分叉部动脉瘤的安全性和有效性。方法回顾性分析2020年7月至2022年10月解放军总医院第一医学中心神经内科医学部采用Neuroform Atlas支架辅助弹簧圈栓塞的21例MCA分叉部动脉瘤患者的临床资料。采用Raymond分级标准评估动脉瘤的栓塞程度,观察围手术期并发症。术后6个月行数字减影血管造影(DSA)检查,评估动脉瘤的栓塞程度及相关并发症。结果21例患者中,18例置入单支架,3例置入双支架,支架均准确定位释放,技术成功率为100%。术后即刻DSA显示,RaymondⅠ级栓塞(完全栓塞)3例(14.3%),Ⅱ级栓塞(次全栓塞)1例(4.8%),Ⅲ级栓塞(不完全栓塞)17例(80.9%)。围手术期2例(9.5%)发生并发症,1例为术中支架内血栓形成,1例术后发生短暂性脑缺血发作;患者均无明显的神经功能缺损症状和体征。术后6个月共13例患者行影像学随访,其中动脉瘤RaymondⅠ级栓塞11例,Ⅱ级栓塞1例,Ⅲ级栓塞1例;1例动脉瘤复发,3例载瘤血管狭窄,1例支架置入对侧的MCA分支闭塞导致新发脑梗死。结论初步证实,Neuroform Atlas支架辅助弹簧圈栓塞MCA分叉部动脉瘤安全性高,短期栓塞效果好。

Objective To investigate the safety and efficacy of Neuroform Atlas stent-assisted coil embolization for treatment of intracranial aneurysms at middle cerebral artery(MCA)bifurcation.Methods A retrospective analysis was conducted on the clinical data of 21 patients with aneurysms at MCA bifurcation who underwent endovascular treatment using Neuroform Atlas device in the Department of Neurology,Chinese PLA General Hospital from July 2020 to October 2022.The immediate postoperative embolization degree was assessed using Raymond grading system and perioperative complications were documented.DSA was performed at 6-month follow-up for evaluation of aneurysm embolization degree and related complications.Results Among 21 cases of MCA bifurcation aneurysms,single-stent treatment was administered in 18 cases and double-stent treatment in 3 cases.All stents were accurately located and implanted.The successful rate of procedure was 100%.As revealed in immediate angiography after the procedure,there were 3 cases(14.3%)of gradeⅠ,1 case(4.8%)of gradeⅡand 17 cases(80.9%)of gradeⅢ.There were 2 perioperative complications documented which included 1 case of in-stent thrombosis developing during surgery and 1 case of postoperative transient ischemic attack.Both of them had no obvious symptom or sign of neurological dysfunction.A total of 13 patients underwent DSA review at 6-month follow-up which revealed gradeⅠin 11 cases,gradeⅡin 1 case and gradeⅢin 1 case.There were 1 case of recurrence,3 cases of in-stent stenosis of parent vessel and 1 case of blocking of MCA branch on the contralateral side of aneurysm.Conclusion It has been preliminarily suggested that application of Neuroform Atlas stent in the treatment of MCA bifurcation aneurysm is associated with high safety and favorable short-term embolization efficacy.