Wakhloo Ajay K, Mandell Jake, Gounis Matthew J, Brooks Christopher, Linfante Italo, Winer Jesse, Weaver John P
Department of Radiology, Division of Neuroimaging and Intervention, University of Massachusetts, Memorial University Campus, Worcester, Massachusetts 01655, USA.
Stroke. 2008 Dec;39(12):3288-96. doi: 10.1161/STROKEAHA.107.512996. Epub 2008 Sep 4.
The purpose of this study was to investigate the periprocedural morbidity, mortality, and long-term clinical and angiographic follow-up using stent-assisted coiling and stenting alone for treatment of cranial fusiform dissecting and atherosclerotic aneurysms.
The Institutional Review Board approved the study. A retrospective analysis was performed of 30 fusiform dissecting and atherosclerotic aneurysms treated in 28 patients (20 females; mean age, 52.6 years). Eleven aneurysms (37%) were located in the posterior circulation. Twenty-one (70%) originated from arterial dissection and 4 aneurysms (13%) presented with subarachnoid bleeding. Twenty-four (80%) aneurysms were treated with stents and coils, whereas 6 (20%) were treated with stents alone.
Immediate postprocedural angiograms in 24 aneurysms treated with stent-assisted coiling showed complete occlusion in 12 and subtotal occlusion in 11 aneurysms, whereas no occlusion was seen in one aneurysm and in all 6 aneurysms treated with stents alone. A clinical improvement or stable outcome was achieved in 25 patients (89%). The 2 cases of permanent morbidity included a patient with a finger dysesthesia associated with a perforator stroke and another patient with hemiparesis and aphasia due to a delayed in-stent thrombosis. One patient died after treatment of a giant vertebrobasilar junction aneurysm. Angiographic follow-up was available in 23 of the 27 surviving patients (85%) at a mean of 16.2 months (range, 1 to 108 months). Recanalization in 4 patients (17%) at 3, 5, 24, and 36 months required retreatment in 3. In-stent stenosis of <or=50% was found in 3 patients.
Stent-assisted coil embolization is an attractive option for ruptured and nonruptured fusiform aneurysms with stable long-term outcome. However, recanalization observed up to 3 years after the initial obliteration emphasizes the need for long-term follow-up angiography.
本研究旨在调查使用支架辅助弹簧圈栓塞术和单纯支架置入术治疗颅内梭形夹层动脉瘤和动脉粥样硬化性动脉瘤的围手术期发病率、死亡率以及长期临床和血管造影随访情况。
机构审查委员会批准了本研究。对28例患者（20例女性；平均年龄52.6岁）所治疗的30个梭形夹层动脉瘤和动脉粥样硬化性动脉瘤进行回顾性分析。11个动脉瘤（37%）位于后循环。21个（70%）起源于动脉夹层，4个动脉瘤（13%）表现为蛛网膜下腔出血。24个（80%）动脉瘤采用支架和弹簧圈治疗，而6个（20%）仅采用支架治疗。
24个采用支架辅助弹簧圈栓塞术治疗的动脉瘤术后即刻血管造影显示，12个完全闭塞，11个次全闭塞，而1个动脉瘤以及所有6个单纯支架治疗的动脉瘤未见闭塞。25例患者（89%）临床症状改善或病情稳定。2例永久性致残病例包括1例因穿支卒中出现手指感觉异常的患者，以及另1例因支架内血栓形成延迟导致偏瘫和失语的患者。1例巨大椎基底动脉交界区动脉瘤患者治疗后死亡。27例存活患者中的23例（85%）进行了血管造影随访，平均随访时间为16.2个月（范围1至108个月）。4例患者（17%）分别在3个月、5个月、24个月和36个月出现再通，其中3例需要再次治疗。3例患者发现支架内狭窄≤50%。
支架辅助弹簧圈栓塞术是破裂和未破裂梭形动脉瘤的一种有吸引力的选择，长期预后稳定。然而，初次闭塞后长达3年观察到的再通情况强调了长期随访血管造影的必要性。
