支架辅助GDC治疗颅内动脉瘤术中并发症的防治

Prevention and management of complications during stent-assisted GDC for intracranial aneurysms

目的 回顾总结血管内支架治疗颅内动脉瘤术中并发症 ,以提高使用血管内支架结合电解可脱卸弹簧圈 (GDC)治疗颅内夹层及宽颈动脉瘤的安全性。方法 10 5例难治性动脉瘤 ,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GDC。结果 6例患者术中出现支架移位 ,1例发生动脉瘤破裂出血 ,1例发生大脑中动脉穿支出血 ,1例发生支架塌陷 ,1例发生颈内动脉夹层动脉瘤 ,1例弹簧圈突入小脑后下动脉 (PICA)起始部 ,10例发生血管痉挛 ,经对症处理 ,预后良好。结论 在支架植入过程中 ,联合采用多种措施可减少并发症的发生 ;支架和GDC联合应用治疗颅内夹层及宽颈动脉瘤安全。

Objective In order to increase the safety of combined endovascular stenting and Guglielmi detachable coils(GDC) packing for the treatment of intracranial fusiform and wide necked aneurysms, we reviewed the complications during stenting. Methods The coronary stents were implanted across the neck of 105 aneurysms refractory to simple GDC coiling. Microcatheters were introduced into the aneurysm sac through stent mesh, and GDCs were used to coil the aneurysms. Results The stent movement and migration occurred in 6 cases of vasospasm in 10. Aneurysm rupture with injury of perforating branch of middle cerebral artery, iatrogenic ICA dissection, and one loop of coil protruding into the PICA origin occurred in every other one of 4 unrelated cases. Stent collapse took place in one case. All complications were respectively treated with excellent results. Conclusions Various techniques should be employed to decrease the rate of complication and led the stent implantation combined with microcoil placement as a safe and effective approach for intracranial fusiform or wide necked aneurysms.