Peluso J P P, van Rooij W J, Sluzewski M, Beute G N
Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands.
AJNR Am J Neuroradiol. 2008 Aug;29(7):1405-8. doi: 10.3174/ajnr.A1104. Epub 2008 Apr 24.
Stent systems for intracranial use are continuously improved. We report our initial experience using a new self-expanding easy-to-place nitinol stent (Enterprise) in the treatment of wide-neck intracranial aneurysms.
Between January and October 2007, 16 aneurysms in 15 patients were treated with stent assistance. Aneurysm size was a mean of 13.2 mm (median, 12 mm; range, 7-30 mm). Eight aneurysms had reopened after prior coiling, and 8 aneurysms were primarily treated, 1 after acute subarachnoid hemorrhage. Response to antiplatelet premedication was tested with a P2Y12 assay before stent placement. On a 3D angiographic workstation, stent placement was simulated to assess vessel caliber and appropriate stent length.
In all aneurysms, the stent could be placed at the exact location as predicted from the computer simulation. Stent placement proved to be technically easy without the need for recapture in all patients. Although placement of the microcatheter through the stent struts and subsequent coil placement was challenging in some patients, coiling after stent placement resulted in complete or near-complete occlusion in all aneurysms. There were no technical or clinical complications. At 6 months, angiographic follow-up in 14 aneurysms revealed 4 aneurysms recanalized to 80% occlusion, 3 of which were additionally coiled.
In this small series, delivery and deployment of the Enterprise stent was technically easy. There were no technical or clinical complications. The device was valuable in the treatment of wide-neck aneurysms. The need for antiplatelet medication in patients treated with this and other stents remains a significant disadvantage.
用于颅内的支架系统在不断改进。我们报告了使用一种新型自膨式、易于放置的镍钛合金支架（Enterprise）治疗宽颈颅内动脉瘤的初步经验。
2007年1月至10月期间，对15例患者的16个动脉瘤进行了支架辅助治疗。动脉瘤平均大小为13.2mm（中位数，12mm；范围，7 - 30mm）。8个动脉瘤在先前的弹簧圈栓塞术后复发，8个动脉瘤为初次治疗，其中1个在急性蛛网膜下腔出血后进行治疗。在支架置入前，通过P2Y12检测评估抗血小板预处理的反应。在三维血管造影工作站上模拟支架置入，以评估血管管径和合适的支架长度。
在所有动脉瘤中，支架均可放置在计算机模拟预测的精确位置。在所有患者中，支架置入在技术上都很容易，无需重新捕捉。尽管在一些患者中，将微导管穿过支架支柱并随后进行弹簧圈置入具有挑战性，但支架置入后进行弹簧圈栓塞导致所有动脉瘤完全或接近完全闭塞。未出现技术或临床并发症。6个月时，对14个动脉瘤的血管造影随访显示，4个动脉瘤再通至80%闭塞，其中3个额外进行了弹簧圈栓塞。
在这个小样本系列中，Enterprise支架的输送和展开在技术上很容易。未出现技术或临床并发症。该装置在宽颈动脉瘤的治疗中具有重要价值。使用该支架及其他支架治疗的患者对抗血小板药物的需求仍然是一个重大缺点。
