Kis Bernhard, Weber Werner, Berlit Peter, Kühne Dietmar
Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, Rheinische Kliniken Essen, Research Unit, Essen, Germany.
Neurosurgery. 2006 Mar;58(3):443-50; discussion 443-50. doi: 10.1227/01.NEU.0000197103.10364.0C.
Endovascular coil embolization of saccular intracranial aneurysms is safe and effective, but long-term results are dissatisfying. Reconstructive treatments using stents improve occlusion rate and protect parent vessels. We present data on our experience with a new self-expanding stent manufactured with braided nitinol wires.
Twenty-five saccular, complex, and broad-necked intracranial aneurysms in 21 patients were treated electively. They were located at the internal carotid artery (10), basilar trunk (5), cavernous carotid artery (4), basilar tip (2), anterior cerebral artery (2), anterior communicating artery (1), and middle cerebral artery (1). Eleven aneurysms exhibited recanalization after primary endovascular treatment without stent.
Stent deployment was successful in 24 lesions, and additional coil embolization was performed in 23. No permanent neurological deficits were encountered consequent to endovascular procedure. Complete or partial occlusion immediately after stent deployment was achieved in 19 aneurysms, whereas no immediate coil embolization was chosen in 6 cases. There were two thromboembolic events related to the deployment of the Leo stent, one failure of stent deployment, difficulties in stent positioning in three cases, and one asymptomatic parent artery occlusion after 7 months. Follow-up (available in 18 patients and 21 aneurysms and obtained at 3-12 mo; average, 5 mo) revealed patent stents in the remaining cases. Angiographic recurrences arose in three lesions, which were retreated without complications.
Primary and recurrence treatment of saccular and broad-necked intracranial aneurysms using the Leo stent is feasible and effective. No permanent neurological deficits were associated with stent placement. Short-term follow-up identified intact parent arteries and stable occlusion rates in the majority of cases.
颅内囊状动脉瘤的血管内弹簧圈栓塞术安全有效，但长期效果不尽人意。使用支架的重建治疗可提高闭塞率并保护载瘤血管。我们展示了使用编织镍钛诺丝制造的新型自膨式支架的经验数据。
对21例患者的25个囊状、复杂和宽颈颅内动脉瘤进行了择期治疗。它们位于颈内动脉（10个）、基底动脉干（5个）、海绵窦段颈内动脉（4个）、基底动脉尖（2个）、大脑前动脉（2个）、前交通动脉（1个）和大脑中动脉（1个）。11个动脉瘤在初次无支架血管内治疗后出现再通。
24个病变成功植入支架，其中23个进行了额外的弹簧圈栓塞。血管内操作未导致永久性神经功能缺损。19个动脉瘤在支架植入后立即实现了完全或部分闭塞，6例未选择立即进行弹簧圈栓塞。有2例血栓栓塞事件与Leo支架植入有关，1例支架植入失败，3例支架定位困难，1例在7个月后出现无症状的载瘤动脉闭塞。随访（18例患者和21个动脉瘤可获得随访数据，随访时间为3 - 12个月；平均5个月）显示其余病例支架通畅。3个病变出现血管造影复发，再次治疗无并发症。
使用Leo支架对囊状和宽颈颅内动脉瘤进行初次和复发治疗是可行且有效的。支架置入未导致永久性神经功能缺损。短期随访显示大多数病例载瘤动脉完好，闭塞率稳定。
