一种专为颅内血管系统设计的新型覆膜支架：在颅内侧颈动脉假性动脉瘤治疗中的应用。
A new covered stent designed for intracranial vasculature: application in the management of pseudoaneurysms of the cranial internal carotid artery.
作者信息
Li M-H, Li Y-D, Gao B-L, Fang C, Luo Q-Y, Cheng Y-S, Xie Z-Y, Wang Y-L, Zhao J-G, Li Y, Wang W, Zhang B-L, Li M
机构信息
Institute of Diagnostic and Interventional Neuroradiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
出版信息
AJNR Am J Neuroradiol. 2007 Sep;28(8):1579-85. doi: 10.3174/ajnr.A0668.
BACKGROUND AND PURPOSE
The management of intracranial pseudoaneurysms is controversial. The purpose of this study was to provide a preliminary evaluation of the clinical efficacy of a Willis covered stent specially designed for the intracranial vasculature in the management of a pseudoaneurysm of the cranial internal carotid artery (CICA).
MATERIALS AND METHODS
Eight patients with pseudoaneurysms of the CICA were treated with use of the Willis covered stent. The flexibility of the entire stent system was gauged from the resistance met when reaching the target lesion and was categorized as no resistance, no apparent resistance, or resistance that could be overcome. The apposition of the Willis stent after deployment was scored as excellent with no endoleak, good with a small endoleak, or bad with an apparent endoleak. Follow-up angiography was performed 3 to 12 months after placement of the stent, and angiographic assessments were categorized as endoleak, stenosis of the covered segment of vessel, or occlusion of parent arteries. Follow-up clinical evaluations were also performed, and outcomes were graded as full recovery, improvement, unchanged, and aggravation.
RESULTS
Endovascular treatment was technically successful in all aneurysms without procedural-related complications, and all of the stents were easily navigated to the targeted lesions in the CICA. Complete resolution of the pseudoaneurysm was observed in 6 patients immediately after the procedure, and a minimal endoleak into the aneurysm persisted in 2 patients. No morbidity or mortality and no technical adverse event occurred. A follow-up angiogram confirmed complete reconstruction of the internal carotid artery, with no recurrent aneurysmal filling and no occurrence of stenosis in the area of the stent. By the final follow-up visit, 4 patients had fully recovered, 3 had improved, and 1 patient's condition was unchanged.
CONCLUSION
On the basis of our preliminary experience, the Willis covered stent specially designed for the intracranial vasculature can manage a CICA pseudoaneurysm safely and effectively, but longer follow-up and expanded clinical trials are needed.
背景与目的
颅内假性动脉瘤的治疗存在争议。本研究的目的是对一种专门为颅内血管系统设计的Willis覆膜支架在治疗颈内动脉颅内段（CICA）假性动脉瘤中的临床疗效进行初步评估。
材料与方法
8例CICA假性动脉瘤患者接受了Willis覆膜支架治疗。根据到达靶病变时遇到的阻力来评估整个支架系统的柔韧性，分为无阻力、无明显阻力或可克服的阻力。Willis支架释放后的贴壁情况分为无内漏为优、有小内漏为良、有明显内漏为差。在支架置入后3至12个月进行随访血管造影，血管造影评估分为内漏、覆膜血管段狭窄或母动脉闭塞。还进行了随访临床评估，结果分为完全恢复、改善、不变和恶化。
结果
所有动脉瘤的血管内治疗在技术上均获成功，无手术相关并发症，所有支架均能轻松到达CICA的靶病变。术后立即观察到6例患者的假性动脉瘤完全消失，2例患者动脉瘤内仍有微量内漏。未发生 morbidity或 mortality，也未发生技术不良事件。随访血管造影证实颈内动脉完全重建，无动脉瘤复发充盈，支架部位无狭窄发生。至末次随访时，4例患者完全恢复，3例患者病情改善，1例患者病情未变。
结论
基于我们的初步经验，专门为颅内血管系统设计的Willis覆膜支架可安全有效地治疗CICA假性动脉瘤，但需要更长时间的随访和扩大临床试验。
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