Department of Neurosurgery, Froedtert Hospital & The Medical College of Wisconsin, Milwaukee, 53226, USA.
Acta Neurochir (Wien). 2009 Dec;151(12):1663-72. doi: 10.1007/s00701-009-0436-9. Epub 2009 Jul 18.
The advent of stent-assisted coil embolization has revolutionized the endovascular management of complex intracranial aneurysms. Although performed routinely in most cerebrovascular centers, there are not many case series reported about the Y-stent technique for coil placement in cerebral aneurysms. The authors present the second largest series available within the neurosurgical literature.
The authors have retrospectively reviewed the medical records and angiographic data of six patients who were diagnosed as having unruptured cerebral aneurysms and subsequently treated using "Y" stent-assisted coil embolization. Five out of six cerebral aneurysms in this study were located at the basilar tip while the remaining one was at the left MCA trifurcation. Aneurysms ranged in size from 8-22 mm. All patients were female with ages ranging from 37-70 years. One patient presented with recurrence of an aneurysm previously managed with a balloon-assisted coil embolization. Another patient presented after a failed trial of a balloon-assisted procedure. One patient had originally been diagnosed with multiple aneurysms of varying size and location.
A "Y" configuration was successfully established in all six patients. Five patients have had a symptom-free recovery period at average follow-up period of 36.7 months. The remaining patient is notable for recurrence that was discovered on angiogram 32 months postoperatively.
The proposed Y-stent technique is a safe and effective option that can be employed in the endovascular reconstruction of unruptured intracranial aneurysms of complex location and orientation. These methods serve as an acceptable alternative in the management of aneurysms traditionally managed with microsurgery. Hemodynamic assessment has shown Y-stenting to be an advantageous therapy option, yet further studies are required to assess these parameters in alternative therapies.
支架辅助弹簧圈栓塞的出现彻底改变了复杂颅内动脉瘤的血管内治疗。尽管在大多数脑血管中心常规进行，但很少有关于颅内动脉瘤线圈放置的 Y 型支架技术的病例系列报道。作者呈现了神经外科学文献中可用的第二大系列。
作者回顾性分析了 6 例诊断为未破裂脑动脉瘤并随后采用“Y”型支架辅助弹簧圈栓塞治疗的患者的病历和血管造影数据。本研究中的 6 个脑动脉瘤中有 5 个位于基底尖，另一个位于左侧 MCA 三分叉处。动脉瘤大小从 8-22mm 不等。所有患者均为女性，年龄 37-70 岁。1 例患者因先前采用球囊辅助弹簧圈栓塞治疗的动脉瘤复发就诊。另 1 例患者因球囊辅助治疗失败而就诊。1 例患者最初被诊断为不同大小和位置的多个动脉瘤。
所有 6 例患者均成功建立了“Y”型支架。5 例患者在平均 36.7 个月的随访期间无症状恢复。另 1 例患者在术后 32 个月发现复发。
提出的 Y 型支架技术是一种安全有效的选择，可用于复杂位置和方向的未破裂颅内动脉瘤的血管内重建。这些方法是传统采用显微手术治疗的动脉瘤的一种可接受的替代方法。血流动力学评估表明 Y 型支架是一种有利的治疗选择，但需要进一步研究来评估替代治疗方法的这些参数。
