Pan Jianwei, Xiao Feng, Szeder Viktor, Yan Ming, Fan Weijian, Gu Jun, He Lingna, Zhan Renya
Zhejiang University, Hangzhou, China.
Neurol Res. 2013 Dec;35(10):1002-8. doi: 10.1179/1743132813Y.0000000234. Epub 2013 Jun 20.
To investigate the clinical application of adjuvant coiling techniques in treating anterior-circulation wide-necked aneurysms.
Over 4·5 years, 93 anterior-circulation wide-neck aneurysms in 81 patients were treated with different endovascular techniques: balloon-assisted, stent-assisted, and double-microcatheter coiling. Demographic, clinical, and angiographic data were reviewed retrospectively.
Of the 93 aneurysms, 45 were treated using stent, 28 using balloon, and 20 using double microcatheter. The proportion of ruptured aneurysms was significantly lower in the stent group (53·3%) than in the balloon (71·4%) or the double-microcatheter group (75%). Stent embolization was used for 61·1% of aneurysms located in the internal carotid artery, whereas aneurysms in the anterior communicating and middle cerebral arteries were mainly treated with balloon remodeling (42·9%) and double microcatheter (52·4%). The majority of aneurysms with neck ≧ 7 mm (87·5%) and all aneurysms with a dome/neck ratio < 1·0 (100%) were treated by stent-assisted coiling. For aneurysms with neck < 4 mm, the mean dome/neck ratio was 0·93 in the stent group, 1·08 in the balloon group, and 1·16 in the double-microcatheter group. Total occlusion was achieved in 21 cases (46·7%), with the rates for stent being significantly lower than for balloon (78·6%) or double microcatheter (75·0%). Clinical outcome was favorable in 73 cases (Glasgow Outcome Scale (GOS) 4-5) and fair in 4 (GOS 3), while 2 were severely disabled (GOS 2) and 2 others died (GOS 1).
Double microcatheter was better for distal aneurysms with dome/neck ratio of 1·1-1·2, while stent was better for proximal aneurysms with an extremely wide neck (≥ 7 mm) and for loudspeaker-shaped aneurysms (dome/neck ratio < 1·0) with poor vessel condition. For emergency cases, both balloon remodeling and double microcatheter are better choices than stent.
探讨辅助弹簧圈栓塞技术在治疗前循环宽颈动脉瘤中的临床应用。
在4.5年的时间里，采用不同的血管内技术治疗了81例患者的93个前循环宽颈动脉瘤，包括球囊辅助、支架辅助和双微导管弹簧圈栓塞。对人口统计学、临床和血管造影数据进行回顾性分析。
93个动脉瘤中，45个采用支架治疗，28个采用球囊治疗，20个采用双微导管治疗。支架组破裂动脉瘤的比例（53.3%）显著低于球囊组（71.4%）和双微导管组（75%）。位于颈内动脉的动脉瘤61.1%采用支架栓塞，而前交通动脉和大脑中动脉的动脉瘤主要采用球囊重塑（42.9%）和双微导管（52.4%）治疗。大多数颈宽≥7mm的动脉瘤（87.5%）和所有瘤颈比<1.0的动脉瘤（100%）采用支架辅助弹簧圈栓塞治疗。对于颈宽<4mm的动脉瘤，支架组的平均瘤颈比为0.93，球囊组为1.08，双微导管组为1.16。21例（46.7%）实现完全栓塞，支架组的栓塞率显著低于球囊组（78.6%）和双微导管组（75.0%）。73例临床预后良好（格拉斯哥预后评分（GOS）4 - 5），4例预后中等（GOS 3），2例严重残疾（GOS 2），2例死亡（GOS 1）。
双微导管对于瘤颈比为1.1 - 1.2的远端动脉瘤效果较好，而支架对于近端极宽颈（≥7mm）动脉瘤和血管条件较差的喇叭形动脉瘤（瘤颈比<1.0）效果较好。对于急诊病例，球囊重塑和双微导管都是比支架更好的选择。
