Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA.
J Neurointerv Surg. 2011 Mar;3(1):14-20. doi: 10.1136/jnis.2010.002303. Epub 2010 Aug 23.
Stent assistance for treatment of wide-based aneurysms is becoming rapidly accepted.
Cases of aneurysms arising in the paraclinoid location of the internal carotid artery treated with intracranial stents and/or bare platinum coils were analyzed retrospectively from our prospectively collected database. We identified 70 aneurysms treated with stent assistance (including one stenting-alone case) and 24 aneurysms treated with coiling alone. Stenting-assisted coiling was achieved either as a one-time treatment or as a two-step maneuver with the stent placed several weeks before coiling, or stent-assisted coiling was used as a second maneuver in aneurysms that recanalized after previous coiling.
In aneurysms treated with stent assistance, 60% had ≥95% occlusion at treatment completion, a result comparing favorably with the 54.2% rate of ≥95% occlusion associated with coiling alone. At last follow-up, 60 aneurysms treated with stent assistance had a 66.7% incidence of ≥95% occlusion, with no in-stent stenosis; 75% of patients treated with coiling alone had ≥95% aneurysm occlusion. Thrombus occurred during stent deployment in two patients, one with and one without neurologic sequelae; stent displacement occurred in one patient without neurologic sequelae. At last follow-up, 57 of 62 patients (91.9%) treated with stent-assisted coiling experienced excellent/good outcomes (modified Rankin scale score ≤2). These results compared favorably with those for the coiling-alone group in which 23 of 24 (95.8%) had good outcomes.
Stent-assisted coiling of paraclinoid aneurysms did not add significantly to morbidity; overall effectiveness was comparable to that of bare coiling of paraclinoid aneurysms. These results require confirmation by a prospective controlled trial.
支架辅助治疗宽基底动脉瘤已迅速得到认可。
从我们前瞻性收集的数据库中回顾性分析了颈内动脉床突旁部位动脉瘤病例，这些病例采用颅内支架和/或裸铂线圈进行治疗。我们共发现 70 例采用支架辅助治疗（包括 1 例单纯支架治疗）和 24 例单纯线圈治疗的动脉瘤。支架辅助线圈治疗采用单次治疗或两步操作完成，支架在数周前放置，或者在先前线圈治疗后再通的动脉瘤中使用支架辅助线圈作为第二阶段操作。
在接受支架辅助治疗的动脉瘤中，60%在治疗完成时达到≥95%的闭塞，这一结果与单纯线圈治疗的 54.2%的≥95%闭塞率相当。在最后一次随访时，60 个接受支架辅助治疗的动脉瘤中有 66.7%达到≥95%的闭塞，支架内无狭窄；75%接受单纯线圈治疗的患者达到≥95%的动脉瘤闭塞。两名患者在支架置入过程中发生血栓形成，其中 1 例有神经后遗症，1 例无神经后遗症；1 例患者发生支架移位，无神经后遗症。在最后一次随访时，57 例（91.9%）接受支架辅助线圈治疗的患者预后良好（改良Rankin 量表评分≤2）。这些结果与单纯线圈治疗组的结果相似，其中 23 例（95.8%）患者预后良好。
支架辅助治疗床突旁动脉瘤并未显著增加发病率；总体疗效与裸线圈治疗床突旁动脉瘤相当。这些结果需要前瞻性对照试验的证实。
