血管内支架治疗颅内动脉瘤和动脉狭窄的安全性和有效性(英文)

Safety and efficacy of endovascular stenting in treatment of intracranial aneurysms and intracranial atherosclerotic stenosis

目的 :探索血管内支架成形术在颅内动脉瘤和动脉狭窄治疗中的安全性和有效性。方法 :7例椎动脉颅内段梭形动脉瘤及 4 5例宽颈动脉瘤 ,首先将冠脉支架跨动脉瘤颈放置 ,通过支架的网孔将微导管送入动脉瘤腔 ,填入电解可脱卸弹簧圈(GDC)。 39例颅内动脉狭窄采用球囊扩张型支架成形术治疗。 结果 :血管内支架均成功植入。 4 2例动脉瘤致密填塞 ,7例大部填塞 ,3例疏松填塞 ;39例颅内狭窄患者中 36例血管直径恢复 80 %以上 ,3例残余狭窄 2 0 %以上。无 1例发生严重的并发症。所有患者临床恢复良好 ,影像学随访无动脉瘤复发 ,载瘤动脉通畅 ;无支架内狭窄和血栓形成。 结论 :联合使用支架及微弹簧圈可能成为治疗颅内梭形及宽颈动脉瘤的有效方法 ,支架成形术治疗颅内动脉狭窄是安全。

Objective:To evaluate safety and efficacy of endovascular stenting for the treatment of intracranial fusiform and wide necked aneurysms and intracranial atherosclerotic stenosis.Methods:Coronary stents were deployed across the neck of 7 fusiform and 45 wide necked aneurysms.Microcatheters were advanced through mesh of the stents,and aneurysms were subsequently embolized with Guglielmi detachable coils(GDC).Thirty nine cases of intracranial atherosclerotic stenoses were treated with stent supported angioplasty.Results:Endovascular stenting was technically successful in all cases.After stent placement and further coiling,total occlusion was achieved in 42 aneurysms,more than 90% occlusion in 9 and loose packing in 3.As for the treatment of intracranial stenosis,stent supported angioplasty was successful in 36 cases (residual stenosis was less than 20%).The residual stenosis was more than 20% in 3 cases.All the patients recovered well with no fatal procedural complications.Short term follow up angiogram revealed no recanalization of aneurysms,no significant restenoses of stented vessels.Conclusion:Combination of stent placement and coil packing is a favorable alternative for the treatment of intracranial fusiform and wide necked aneurysms.Stent supported angioplasty is feasible and safe for the treatment of intracranial atherosclerotic stenoses.