Lee Young-Jun, Kim Dong Joon, Suh Sang Hyun, Lee Seung-Koo, Kim Jinna, Kim Dong Ik
Department of Diagnostic Radiology, Pochon CHA University College of Medicine, Bundang CHA Hospital, 351 Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-712, South Korea.
Neuroradiology. 2005 Sep;47(9):680-9. doi: 10.1007/s00234-005-1402-8. Epub 2005 Jul 19.
The endovascular treatment of cerebral aneurysms with coils poses significant technical challenges, particularly with respect to wide-necked aneurysms. We present the results of our initial experiences in using a stent for endovascular treatment of aneurysms, with an emphasis on potential applications, technical aspects, and associated complications. Twenty-three wide-necked aneurysms from 22 patients were treated during the 13-month study period. Seven patients presented with subarachnoid hemorrhage. Aneurysms were located at the internal carotid artery (n=14), the vertebral artery (n=3), the basilar artery (n=5), and the middle cerebral artery (n=1). A Neuroform stent2 was used for stent-assisted procedures. Premedication with antithrombotic agents was available for unruptured cases. Postprocedural antithrombotic medication was prescribed for all patients. Nineteen aneurysms were primarily stented, followed by coil placement. For five of these aneurysms, stenting was performed subsequent to failure of an attempt to frame with an initial coil. Stenting for the remaining four aneurysms was performed as a rescue procedure to prevent the migration of previously placed coils. Complete occlusion was obtained in ten aneurysms, nearly complete occlusion (95% or more occluded) in 11 aneurysms, and partial occlusion (less than 95% occluded) in one aneurysm. In one aneurysm, we failed to navigate the microcatheter into the aneurysmal sac through the interstices of the stent. Stent thrombosis was noted during the procedure in one patient. Hemorrhagic complication on the 25th day after the procedure was noted in one patient. No procedure-related complications were observed during the procedure or during follow-up in the remaining 20 patients, including seven patients who did not receive antithrombotic agents prior to endovascular treatment owing to recent subarachnoid hemorrhage. To overcome the technical limitation in the coiling of wide-necked aneurysms, stent-assisted coil embolization may be a technically feasible and relatively safe method, even though longer periods of follow-up are required.
使用弹簧圈进行脑动脉瘤的血管内治疗面临重大技术挑战，尤其是对于宽颈动脉瘤。我们展示了我们使用支架进行动脉瘤血管内治疗的初步经验结果，重点关注潜在应用、技术方面及相关并发症。在为期13个月的研究期间，对22例患者的23个宽颈动脉瘤进行了治疗。7例患者出现蛛网膜下腔出血。动脉瘤位于颈内动脉（n = 14）、椎动脉（n = 3）、基底动脉（n = 5）和大脑中动脉（n = 1）。使用Neuroform支架2进行支架辅助手术。未破裂病例可使用抗血栓药物进行预处理。所有患者术后均开具抗血栓药物。19个动脉瘤首先进行支架置入，随后进行弹簧圈置入。其中5个动脉瘤在初次尝试用弹簧圈成篮失败后进行了支架置入。其余4个动脉瘤的支架置入作为挽救措施，以防止先前置入的弹簧圈移位。10个动脉瘤实现完全闭塞，11个动脉瘤接近完全闭塞（闭塞率达95%或更高），1个动脉瘤部分闭塞（闭塞率低于95%）。在1例患者中，我们未能通过支架间隙将微导管送入动脉瘤囊内。1例患者在手术过程中出现支架血栓形成。1例患者在术后第25天出现出血并发症。其余20例患者在手术过程中及随访期间未观察到与手术相关的并发症，包括7例因近期蛛网膜下腔出血在血管内治疗前未接受抗血栓药物治疗的患者。为克服宽颈动脉瘤弹簧圈栓塞的技术局限性，支架辅助弹簧圈栓塞可能是一种技术上可行且相对安全的方法，尽管需要更长时间的随访。
