Luo Chao-Bao, Wei Chao-Jung, Chang Feng-Chi, Teng Michael Mu-Huo, Lirng Jiing-Feng, Chang Cheng-Yen
Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2003 Aug;66(8):460-6.
Endovascular embolization of wide neck aneurysm often results in incomplete occlusion or aneurysm recurrence. The purpose of this study is to assess the efficacy and safety of stent-assisted embolization of wide neck aneurysms of the internal carotid artery (ICA).
A series of 10 patients with ICA aneurysms attempted treatment by stent-assisted Guglielmi detachable coil (GDC) embolization (n = 9) or by stent alone (n = 1). There were 3 men and 7 women ranging in age from 21 to 78 years, with a mean of 51 years. The indications of stenting were wide neck aneurysms (n = 9) and herniation of detached coils from aneurysmal sac into parent artery (n = 1).
Endovascular stent placement was technically successful in 8 cases. In one case with a cervical big ICA aneurysm, a stent was placed across the neck of aneurysm without deposition of embolic material into the aneurysmal sac. The initial control angiogram revealed residual aneurysm; however, complete obliteration of aneurysmal sac was achieved as observed on angiograms in 8 months. Six cases of wide neck aneurysms were successfully treated by stent-assisted GDC embolization. One case had prolapse of coil loops into parent artery after coils detached; the coil loops were successfully pushed back to aneurysm after stent placement. Two patients had difficulties to navigate the stents across the aneurysm necks because of tortuous parent arteries; in one of them, the stent partially covered the neck of aneurysm, which made the success of subsequent GDC embolization; in the other one, advancement of the stent to the targeted site was abortive, and the aneurysm was eventually loose packing. No significant procedure-related complication was found. One patient had asymptomatic dissection of the parent artery after stent placement. One patient had a transient ischemic attack and returned to normal baseline neurological conditions later. Clinical follow-up for these patients was 0.5 to 36 months, with a mean of 14 months.
Stent-assisted embolization is a treatment of choice for wide neck aneurysms or for patient with herniation of coil loops to parent artery after coil detached. It was proven both safe and effective over a relatively long follow-up.
宽颈动脉瘤的血管内栓塞术常常导致栓塞不完全或动脉瘤复发。本研究的目的是评估支架辅助栓塞颈内动脉（ICA）宽颈动脉瘤的有效性和安全性。
一系列10例ICA动脉瘤患者尝试接受支架辅助Guglielmi可脱卸弹簧圈（GDC）栓塞治疗（9例）或单纯支架治疗（1例）。其中男性3例，女性7例，年龄21至78岁，平均51岁。支架置入的适应证为宽颈动脉瘤（9例）和弹簧圈从动脉瘤囊脱入载瘤动脉（1例）。
血管内支架置入技术上成功8例。1例颈段巨大ICA动脉瘤患者，支架跨过动脉瘤颈部置入，但未向动脉瘤囊内注入栓塞材料。初始对照血管造影显示动脉瘤残留；然而，8个月后的血管造影显示动脉瘤囊完全闭塞。6例宽颈动脉瘤成功接受支架辅助GDC栓塞治疗。1例弹簧圈脱落后弹簧圈圈袢脱垂至载瘤动脉，支架置入后弹簧圈圈袢成功推回动脉瘤内。2例患者因载瘤动脉迂曲，支架难以跨过动脉瘤颈部；其中1例，支架部分覆盖动脉瘤颈部，使得随后的GDC栓塞成功；另1例，支架未能推进至目标部位，最终对动脉瘤进行了疏松填塞。未发现明显的与手术相关的并发症。1例患者支架置入后出现无症状的载瘤动脉夹层。1例患者发生短暂性脑缺血发作，随后恢复至正常基线神经状态。这些患者的临床随访时间为0.5至36个月，平均14个月。
支架辅助栓塞术是宽颈动脉瘤或弹簧圈脱落后弹簧圈圈袢脱垂至载瘤动脉患者的治疗选择。在相对较长的随访中已证实其安全有效。
