血管内支架结合弹簧圈治疗颅内宽颈动脉瘤的临床研究

Clinical study of endovascular stenting combined with coiling for treatment of intracranial wide-necked aneurysms

目的 探讨血管内支架结合电解可脱卸弹簧圈 (GDC)治疗颅内宽颈动脉瘤的适应证、技术要点、并发症防治及疗效 ,评估该技术的安全性及疗效。方法 10 5例颅内宽颈动脉瘤 (前循环 78例 ,后循环 2 7例 ) ,首先将冠脉支架跨动脉瘤颈放置 ,通过支架上的网孔将微导管送入动脉瘤腔 ,填塞GDC ,术后 3、6、12个月随访临床症状 ,6～ 12个月脑血管造影随访。结果 10 4例手术成功 ,1例失败 ;80例动脉瘤达到致密填塞 ,2 4例大部填塞 ,载瘤动脉通畅 ;1例术中发生脑梗死 ,1例发生颈动脉夹层动脉瘤 ,1例术中动脉瘤破裂 ,1例在GDC填塞过程中支架完全塌陷。 98例临床随访 3～ 3 2个月 ,均无再出血或血栓栓塞的症状。血管造影随访 62例 (随访期 6～ 12个月 ) ,60例动脉瘤不再显影 ,2例明显缩小 ,1例出现支架近端轻度狭窄。结论 联合使用支架和微弹簧圈是治疗颅内宽颈动脉瘤安全有效的方法 ,支架使宽颈动脉瘤的介入治疗成为可能 ,支架不但可防止弹簧圈突入载瘤动脉 ,还可防止弹簧圈压缩 ,促进瘤内血栓形成 ,防止动脉瘤复发 。

Objective To report experience of endovascular stenting combined with coiling for intracranial wide necked aneurysms and to investigate its indication, technical tip, prevention and treatment of complication, safety and efficacy. Methods The coronary stents were implanted across the neck of intracranial wide necked aneurysms in 105 patients (78 located in anterior circulation and 27 in posterior circulation). Microcatheters were introduced into the aneurysm sac through stent mesh. GDCs were used to embolize the aneurysms . Results The stents were deployed in 104 patients and total occlusion was obtained in 80 cases and more than 90% in 24 cases. The patients recovered well with patency of the parent arteries except one with cerebral infarction and another with carotid dissection during the procedure. The stent collapsed in one case after coiling.No re bleeding or symptom related to thrombosis occurred during clinical follow up for 3 28 months. Follow up angiogram in 62 cases showed no recanalization in all patients, but two with further thrombosis and one with mild stenosis in proximal segment of the stent. Conclusions Endovascular therapy combined stent implantation and microcoil placement would be a valid alteration for the treatment of complicated intracranial aneurysms. However, long term outcome need further study.