Kim S R, Vora N, Jovin T G, Gupta R, Thomas A, Kassam A, Lee K, Gologorsky Y, Jankowitz B, Panapitiya N, Aleu A, Sandhu E, Crago E, Hricik A, Gallek M, Horowitz M B
Department of Neurosurgery, Holy Family Hospital, The Catholic University of Korea, Department of Neurosurgery,Minimally Invasive Endo-Neurosurgery Center, Presbyterian Hospital,University of Pittsburgh Medical Center, U.S.A -
Interv Neuroradiol. 2008 Sep 30;14(3):267-84. doi: 10.1177/159101990801400307. Epub 2008 Oct 8.
The purpose of this study was to evaluate and report our anatomic results and complications associated with stent-assisted coil embolization of intracranial aneurysms using the Neuroform stent. From September 2003 to August 2007, 127 consecutive patients (ruptured 50, 39.4%; unruptured 77, 60.6%) underwent 129 stent-assisted coil embolization procedures to treat 136 aneurysms at our institution. Anatomic results at follow-up, procedure-related complications, and morbidity/mortality were retrospectively reviewed. Stent deployment was successful in 128 out of 129 procedures (99.2%). Forty-seven patients presented with 53 procedure-related complications (37.0%, 47/127). Thromboembolic events (n=17, 13.4%) were the most common complications, followed by intraoperative rupture (n=8, 6.3%), coil herniation (n=5, 3.9%), and postoperative rupture (n=4, 3.1%). For thromboembolic events, acute intra-procedural instent thromboses were observed in two patients and subacute or delayed in-stent thromboses in three patients. Overall mortality rate was 16.5% (21/127) and procedure-related morbidity and mortality rates were 5.5% (7/127) and 8.7% (11/127) retrospectively. Patients with poor grade subarachnoid hemorrhage (Hunt and Hess grade IV or V; 25/127, 19.7%) exhibited 56% (14/25) overall mortality rate and 24% (6/25) procedure-related mortality rate. Immediate angiographic results showed complete occlusion in 31.7% of aneurysms, near-complete occlusion in 45.5%, and partial occlusion in 22.8%. Sixty nine patients in 70 procedures with 77 aneurysms underwent angiographic followup at six months or later. Mean follow-up period was 13.7 months (6 to 45 months). Complete occlusion was observed in 57 aneurysms (74.0%) and significant in-stent stenosis was not found. Thromboembolism and intra/postoperative aneurysm ruptures were the most common complications and the main causes of procedure-related morbidity and mortality. Patients with poor grade subarachnoid hemorrhage showed poor clinical outcomes. Since most complications were induced by stent manipulation and deployment, it is mandatory to utilize these devices selectively and cautiously. While the follow- up angiographic results are promising, further studies are essential to evaluate safety, efficacy, and durability of the Neuroform stent.
本研究的目的是评估并报告使用Neuroform支架进行颅内动脉瘤支架辅助弹簧圈栓塞术的解剖学结果及相关并发症。2003年9月至2007年8月，我院连续127例患者（50例破裂，占39.4%；77例未破裂，占60.6%）接受了129次支架辅助弹簧圈栓塞术，以治疗136个动脉瘤。对随访时的解剖学结果、与手术相关的并发症以及发病率/死亡率进行了回顾性分析。129例手术中有128例（99.2%）成功植入支架。47例患者出现53例与手术相关的并发症（37.0%，47/127）。血栓栓塞事件（n = 17，13.4%）是最常见的并发症，其次是术中破裂（n = 8，6.3%）、弹簧圈疝出（n = 5，3.9%）和术后破裂（n = 4，3.1%）。对于血栓栓塞事件，2例患者术中出现急性支架内血栓形成，3例患者出现亚急性或延迟性支架内血栓形成。总体死亡率为16.5%（21/127），回顾性分析显示与手术相关的发病率和死亡率分别为5.5%（7/127）和8.7%（11/127）。蛛网膜下腔出血分级较差（Hunt和Hess分级IV或V级；25/127，19.7%）的患者总体死亡率为56%（14/25），与手术相关的死亡率为24%（6/25）。即刻血管造影结果显示31.7%的动脉瘤完全闭塞，45.5%接近完全闭塞，22.8%部分闭塞。70例手术中的69例患者（共77个动脉瘤）在6个月或更晚进行了血管造影随访。平均随访期为13.7个月（6至45个月）。57个动脉瘤（74.0%）观察到完全闭塞，未发现明显的支架内狭窄。血栓栓塞和术中/术后动脉瘤破裂是最常见的并发症，也是与手术相关的发病率和死亡率的主要原因。蛛网膜下腔出血分级较差的患者临床预后较差。由于大多数并发症是由支架操作和植入引起的，必须谨慎、有选择地使用这些器械。虽然随访血管造影结果令人鼓舞，但有必要进一步研究以评估Neuroform支架的安全性、有效性和耐用性。
