Cohen José E, Ferrario Angel, Ceratto Rosana, Miranda Carlos, Lylyk Pedro
Department of Neurosurgery and Neuroendovascular Surgery, Hadassah Medical Center, POB 12000, 91120 Jerusalem, Israel.
Neurol Res. 2003 Jul;25(5):492-6. doi: 10.1179/016164103101201904.
We report a unique case of endovascular arterial reconstruction using stent and coils in a symptomatic cavernous aneurysm presented in infancy. A 3-year-old infant presented with a partial cavernous sinus syndrome secondary to a bilobulate cavernous aneurysm with subarachnoid extension. Direct clipping represented a considerable challenge and trapping after bypass grafting was considered to risky. A combined endovascular approach using stent and coils was performed. A 4 x 18 mm balloon-expandable stent was then placed across the aneurysm orifice allowing the complete obliteration of the remnant with coils implanted through the stent mesh. Digital substraction angiography documented patency of the ICA lumen and complete obliteration of the aneurysm. A 24-months angiographic follow-up was performed confirming persistent aneurysm exclusion and patency of the parent vessel with no signs of in-stent de novo stenosis. Reconstructive endovascular technique using stent and coils allowed the treatment of a complex vascular condition. The cavernous lesion was excluded from the circulation while preserving normal flow through the parent vessel and its branches. Long-tern follow up is a major concern, specially in pediatric patients but the 24 months angiographic follow-up is encouraging.
我们报告了一例独特的病例，即对一名婴儿期出现症状的海绵状动脉瘤采用支架和弹簧圈进行血管内动脉重建。一名3岁婴儿因双叶状海绵状动脉瘤伴蛛网膜下腔扩展继发部分海绵窦综合征。直接夹闭是一项巨大挑战，而旁路移植术后进行包裹术被认为风险很大。于是采用了支架和弹簧圈联合血管内治疗方法。随后，在动脉瘤开口处放置了一个4×18毫米的球囊扩张支架，通过支架网植入弹簧圈，从而完全闭塞动脉瘤残余部分。数字减影血管造影显示颈内动脉管腔通畅，动脉瘤完全闭塞。进行了24个月的血管造影随访，证实动脉瘤持续被排除，供血血管通畅，没有支架内新生狭窄的迹象。使用支架和弹簧圈的重建性血管内技术能够治疗复杂的血管疾病。海绵状病变被排除在血液循环之外，同时保持供血血管及其分支的正常血流。长期随访是一个主要问题，尤其是在儿科患者中，但24个月的血管造影随访结果令人鼓舞。
