dos Santos Souza Marlise Peruzzo, Agid Ronit, Willinsky Robert A, Cusimano Michael, Montanera Walter, Wallace M Christopher, terBrugge Karel G, Marotta Thomas R
Department of Medical Imaging, St. Michael's Hospital, University Health Network, Toronto, Ontario, Canada.
Can J Neurol Sci. 2005 Feb;32(1):71-81. doi: 10.1017/s0317167100016917.
To describe the results, technical feasibility, efficacy and challenges encountered in our preliminary experience using a self-expandable microstent, optimized for intracranial use, as an adjunct in the endovascular treatment of wide-necked aneurysms.
Only broad-necked aneurysms (dome-to-neck ratio < or = 2, or an isolated neck size > 4.5 mm) were treated with Neuroform microstent from July 2003 to May 2004. The techniques used for stent deployment were either parallel or sequential. Angiographic results were recorded immediately for all patients and classified as Class 1 (complete occlusion), Class 2 (neck remnant) or Class 3 (sac remnant) by three interventional neuroradiologists not involved in the procedure. Follow-up angiography at six months was obtained for one case. Modified Rankin Score scale was assessed for all patients.
Seventeen intracranial aneurysms in a total of 18 patients were treated (mean age, 52.2 yr). Eight patients (44.4%) presented with acute subarachnoid hemorrhage. Eleven aneurysms (61.1%) were in the posterior circulation. Average dome size was 10.2 mm (range, 3.7-19.8 mm) and average neck size was 5.36 mm (range, 3.0-10.0 mm). Six out of seven aneurysms of the anterior circulation were approached with parallel technique. Eight aneurysms of the posterior circulation were approached with sequential technique. Average number of coils deployed was 9.64 (range, 4-23 coils). Eleven aneurysms (64.8%) resulted in Class 1 and/or Class 2. One technical failure was observed. Technical complications were recognized in four patients (23.5%), all of them with unruptured aneurysms in the anterior circulation. Two patients (11.7%) presented transient immediate clinical complications. One patient (5.8%) had minor permanent neurological complication. Neither major clinical complications nor death were encountered. Favorable clinical outcome (Modified Rankin Scale score 0-2) was observed in 88.2% of the patients (average follow-up time, 4.72 months).
Absence of major permanent complications and satisfactory immediate obliteration degree in our preliminary experience indicates that microstent-assisted coiling technique is useful for the minimally invasive treatment of broad-necked complex aneurysms that are not ideal for conventional endovascular treatment and are at a high risk for conventional surgical treatment.
描述我们在初步经验中使用一种专为颅内使用优化的自膨式微支架作为宽颈动脉瘤血管内治疗辅助手段时所取得的结果、技术可行性、疗效及遇到的挑战。
2003年7月至2004年5月期间，仅对宽颈动脉瘤（瘤顶与瘤颈比≤2，或孤立瘤颈尺寸＞4.5mm）使用Neuroform微支架进行治疗。支架置入所采用的技术为平行技术或序贯技术。所有患者均立即记录血管造影结果，由3名未参与该手术的介入神经放射科医生将其分类为1级（完全闭塞）、2级（瘤颈残留）或3级（瘤囊残留）。对1例患者进行了6个月的随访血管造影。对所有患者评估改良Rankin评分量表。
共治疗了18例患者的17个颅内动脉瘤（平均年龄52.2岁）。8例患者（44.4%）表现为急性蛛网膜下腔出血。11个动脉瘤（61.1%）位于后循环。平均瘤顶尺寸为10.2mm（范围3.7 - 19.8mm），平均瘤颈尺寸为5.36mm（范围3.0 - 10.0mm）。前循环的7个动脉瘤中有6个采用平行技术处理。后循环的8个动脉瘤采用序贯技术处理。平均置入的弹簧圈数量为9.64个（范围4 - 23个弹簧圈）。11个动脉瘤（64.8%）达到1级和/或2级。观察到1例技术失败。4例患者（23.5%）出现技术并发症，均为前循环未破裂动脉瘤。2例患者（11.7%）出现短暂的即时临床并发症。1例患者（5.8%）有轻微的永久性神经并发症。未出现重大临床并发症及死亡情况。88.2%的患者获得了良好的临床结局（改良Rankin量表评分为0 - 2）（平均随访时间4.72个月）。
在我们的初步经验中，未出现重大永久性并发症且即时闭塞程度令人满意，这表明微支架辅助弹簧圈栓塞技术对于传统血管内治疗不理想且传统手术治疗风险高的宽颈复杂动脉瘤的微创治疗是有用的。
