Won Yu Sam, Rho Myung Ho, Kim Byung Moon, Park Hee Jin, Kwag Hyon Ju, Chung Eun Chul
Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2013 May;53(5):274-80. doi: 10.3340/jkns.2013.53.5.274. Epub 2013 May 31.
To evaluate the feasibility and clinical and angiographic outcomes of stent-assisted embolization for complex middle cerebral artery (MCA) aneurysms.
The records of 23 consecutive patients with 24 MCA aneurysms, who underwent stent-assisted embolization of the aneurysm, were retrospectively evaluated.
Fifteen aneurysms were treated with one stent and 8 were treated using more than two stents (5 a stent-within-a-stent, 1 triple stents, and two Y-stent). Angiographically, complete or near complete occlusion was achieved in 15 aneurysms (65.2%), residual neck in five (21.7%), and residual aneurysm in three (13.1%). Five aneurysms demonstrated thrombosis within the stent during the procedure and hospitalization, and were resolved by intraarterial and intravenous Tirofiban injection. Symptomatic thromboembolic complications were developed in five patients and permanent deficits demonstrated in two patients with modified Rankin Scale 1 and 2, respectively. Treatment-related permanent morbidity and mortality rates were 8.3% and 0% with relatively high complication rate. Angiographic follow-up was available in 17 aneurysms at 6-31 months (mean, 13.2 months) and showed stable or improved in 15 (88.2%) and major and minor recurrence in one, respectively.
Complex MCA aneurysms could be treated by stent-assisted coiling and showed lower recanalization rate during mid-term follow-up by effective flow diversion due to various stent-assisted techniques. Our results warrant further study with a longer follow-up period in a larger sample.
评估支架辅助栓塞治疗复杂大脑中动脉（MCA）动脉瘤的可行性、临床及血管造影结果。
回顾性分析连续23例患有24个MCA动脉瘤并接受动脉瘤支架辅助栓塞治疗患者的记录。
15个动脉瘤采用单支架治疗，8个采用两个以上支架治疗（5个采用套叠支架，1个采用三层支架，2个采用Y形支架）。血管造影显示，15个动脉瘤（65.2%）实现完全或接近完全闭塞，5个（21.7%）有残余瘤颈，3个（13.1%）有残余动脉瘤。5个动脉瘤在手术及住院期间支架内出现血栓形成，通过动脉内及静脉内注射替罗非班得以解决。5例患者出现有症状的血栓栓塞并发症，2例患者分别出现改良Rankin量表评分为1分和2分的永久性神经功能缺损。治疗相关的永久性致残率和死亡率分别为8.3%和0%，并发症发生率相对较高。17个动脉瘤在6至31个月（平均13.2个月）进行了血管造影随访，其中15个（88.2%）显示稳定或改善，1个出现主要和次要复发。
复杂MCA动脉瘤可通过支架辅助弹簧圈栓塞治疗，由于采用了各种支架辅助技术，通过有效的血流导向，在中期随访期间再通率较低。我们的结果值得在更大样本、更长随访期的进一步研究。
