Neuroform Atlas支架在颈内动脉小型和微小型动脉瘤中的应用分析

Application of the Neuroform Atlas stent in small and micro aneurysms of the internal carotid artery

目的探讨在颈内动脉小型和微小型动脉瘤中使用Neuroform Atlas支架治疗的安全性和有效性。方法回顾性分析2020年8月-2023年8月58例应用Neuroform Atlas支架辅助弹簧圈栓塞颈内动脉小型和微小型动脉瘤患者的临床资料,小型动脉瘤有42例(72.4%),微小型动脉瘤有16例(27.6%)。结果56例患者在Neuroform Atlas支架辅助下顺利完成栓塞,2例(3.4%)患者术中首次置入支架失败;术中发生动脉瘤破裂2例(3.4%),术后发生缺血性事件2例(3.4%)。术后即刻造影中小型动脉瘤Raymond分级Ⅰ级33例(78.6%),Ⅱ级6例(14.3%),Ⅲ级3例(7.1%);微小型动脉瘤Raymond分级Ⅰ级7例(43.8%),Ⅱ级8例(50.0%),Ⅲ级1例(6.2%)。小型动脉瘤术后即刻造影栓塞程度优于微小型动脉瘤(P<0.05)。术后3~6个月随访造影小型动脉瘤Raymond分级Ⅰ级38例(90.5%),Ⅱ级3例(7.1%),Ⅲ级1例(2.4%);微小型动脉瘤Raymond分级Ⅰ级13例(81.2%),Ⅱ级2例(12.5%),Ⅲ级1例(6.3%),两者比较无明显差异(P>0.05)。术后第1个月改良Rankin量表(modified Rankin scale,mRS)评分0~2分有51例,并在术后第6个月全部患者评分均达到0~2分,小型动脉瘤和微小型动脉瘤患者术后mRS评分无明显差异(P>0.05)。结论Neuroform Atlas支架辅助弹簧圈在治疗颈内动脉小型及微小型动脉瘤中术中置入成功率较高,且术中及术后的并发症发生率低,患者远期预后良好。

Objective To investigate the safety and efficacy of the Neuroform Atlas stent in the treatment of small and micro internal carotid artery aneurysms.Methods The clinical data of 58 patients with small or micro internal carotid artery aneurysms embolized with Neuroform Atlas stent-assisted coils from August 2020 to August 2023 were analyzed retrospectively.There were 42 cases(72.4%)of small aneurysms and 16 cases(27.6%)of microaneurysms.Results Intraoperative stent implantation failed in 2 patients(3.4%),and the rest 56 patients were embolized with the assistance of Neuroform Atlas stents.Intraoperative aneurysm rupture occurred in 2 cases(3.4%)and postoperative ischemic event occurred in 2 cases(3.4%).Immediately after operation,Raymond gradeⅠwas observed in 33 cases(78.6%),gradeⅡin 6 cases(14.3%)and gradeⅢin 3 cases(7.1%)of small aneurysms,respectively.In microaneurysm cases,Raymond gradeⅠwas in 7 cases(43.8%),gradeⅡin 8 cases(50.0%)and gradeⅢin 1 case(6.2%),respectively.The embolization degree of small aneurysms immediately after operation was better than that of microaneurysms(P<0.05).During the follow-up of 3~6 months after operation,there were 38 cases of Raymond gradeⅠ(90.5%),3 cases of gradeⅡ(7.1%),1 case of gradeⅢ(2.4%)in patients with small aneurysms,and 13 cases of Raymond gradeⅠ(81.2%),2 cases of gradeⅡ(12.5%),1 case of gradeⅢ(6.3%)in patients with microaneurysms.There was no significant difference between the two groups(P>0.05).One month after operation,there were 51 cases whose modified Rankin scale(mRS)score was between 0 and 2,and at six months after operation,mRS score of all the patients was between 0 and 2.There was no significant difference in postoperative mRS scores between patients with small aneurysms and patients with microaneurysms.Conclusion The success rate of Neuroform Atlas stent-assisted coil implantation in the treatment of small and micro internal carotid artery aneurysms is high,and the incidence of intraoperative and postoperative complications is low,and the long-term prognosis of the patients is good.