LEO支架构建crossing Y形支架辅助栓塞治疗颅内动脉分叉部宽颈动脉瘤的安全性和有效性分析

Safety and efficiency of crossing Y-stent-assisted coiling with LEO stents in treatment of wide-necked intracranial bifurcation aneurysms

目的探讨使用LEO支架构建crossing Y形支架辅助栓塞治疗颅内动脉分叉部宽颈动脉瘤的安全性和有效性。方法收集2018-2022年陆军军医大学第一附属医院神经外科收治的336例颅内动脉分叉部宽颈动脉瘤患者的临床资料及随访影像,其中55例患者采用LEO支架构建crossing Y形支架辅助栓塞治疗。观察使用LEO支架构建crossing Y形支架辅助栓塞治疗动脉瘤的成功率、手术相关并发症、围手术期缺血和出血并发症的发生率。采用改良Rankin评分(modified Rankin scale,mRS)量表评价患者出院及临床随访时的神经功能恢复情况,使用术后即刻及随访脑血管造影Raymond分级评估栓塞效果、术后随访CTA及MRA评估有无复发。结果55例颅内动脉分叉部宽颈动脉瘤患者均成功栓塞,未见支架打开不良、支架打折等不良事件;术中支架内血栓形成1例(1.82%),迟发性缺血2例(3.64%),未见围手术期出血事件。术后即刻造影致密栓塞(RaymondⅠ级)50例(90.91%),瘤颈残留(RaymondⅡ级)3例(5.45%),RaymondⅢ级2例(3.64%)。40例患者于术后6~24个月获得影像随访,造影RaymondⅠ级38例(95%),RaymondⅡ级2例(5%);9例患者行CTA或MRA复查未见复发;术后随访动脉瘤栓塞效果较术后即刻好转。出院时mRS评分0~1分50例,2分1例,3分1例,4分2例,5分1例。获得4~24个月临床随访预后,mRS评分0~1分50例,2分2例,3分1例,4分1例,6分1例;出院时mRS评分较差患者临床随访mRS评分好转。结论使用LEO支架构建crossing Y形支架辅助栓塞治疗颅内动脉分叉部宽颈动脉瘤成功率及安全性高,复发率低,围手术期缺血事件发生率低,近期疗效可,远期疗效待进一步观察。

Objective To explore the safety and efficiency of crossing Y-stent-assisted coiling with LEO stents in treatment of wide-necked intracranial bifurcation aneurysms.Methods The clinical data and follow-up images of 336 patients with wide-necked intracranial bifurcation aneurysms admitted to the neurosurgery department of the First Affiliated Hospital of Army Medical University from 2018 to 2022 were collected and analyzed retrospectively.Among them,55 patients received crossing Y-stent-assisted coiling with LEO stents.The success rate of aneurysm treatment,operation-related complications,incidences of perioperative ischemic and hemorrhagic complications were observed.Raymond classification were conducted on cerebral angiographs immediately after operation and at the end of follow-up to evaluate the efficiency of embolization.Modified Rankin Scale(mRS)was used to evaluate the neurological function of the patients at discharge and during clinical follow-up.Computed tomography angiography(CTA)and magnetic resonance angiography(MRA)were performed to evaluate the recurrence rate during postoperative follow-up.Results Successful embolization was performed in the 55 patients with LEO stent-based crossing Y-shaped stenting,and no adverse events such as poor stent opening or stent folding were observed.Intraoperative stent thrombosis occurred in 1 case(1.82%),delayed ischemia in 2 cases(3.64%),and no perioperative bleeding events was observed.Immediate postoperative angiography showed dense embolism(Raymond classⅠ)in 50 cases(90.91%),residual tumor neck(Raymond classⅡ)in 3 cases(5.45%),and Raymond classⅢin 2 cases(3.64%).The imaging results of 40 patients during a follow-up from 6 months to 2 years postoperatively revealed that 38 cases(95%)were at Raymond ClassⅠand 2 cases(5%)at Raymond ClassⅡ.For the 9 patients undergoing CTA or MRA re-examination,no recurrence was observed.The imaging results during postoperative follow-up indicated that efficiency improvement was achieved in all cases when compared to the conditions immediately after operation.At discharge,50 cases had a mRS score of 0~1,1 case of 2,1 case of 3,2 cases of 4,and 1 case of 5.The mRS scores were obviously improved in a follow-up period from 4 to 24 months,with 52 cases having a score of 0~1,1 case of 2,1 case of 3,1 case of 4,and 1 case of 6.Conclusion Crossing Y-stent-assisted coiling with LEO stents has advantages of high success rate and safety,low recurrence rate and incidence of perioperative ischemic events,and sound short-term efficacy in treatment of wide-necked intracranial bifurcation aneurysms.But further observation is needed for long-term efficacy.