Jeon Pyoung, Kim Byung Moon, Kim Dong Joon, Kim Dong I K, Park Keun Young
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Acta Neurochir (Wien). 2014 Sep;156(9):1677-86. doi: 10.1007/s00701-014-2163-0. Epub 2014 Jun 27.
This study aimed to evaluate clinical and angiographic outcomes of Y-configuration double-stent-assisted (Y-stent) coiling using two closed-cell stents for wide-necked basilar tip aneurysm (BTA).
A total of 25 patients underwent Y-stent coiling using two closed-cell stents as a first-time treatment in 18 (3 ruptured) BTAs, retreatment in 2 BTAs and as a third treatment in 5 wide-necked BTAs. Clinical and angiographic outcomes were evaluated retrospectively.
Treatment-related complications were three (12.0 %) thromboembolic infarctions due to two acute in-stent thromboses and one embolism. Twenty-two (88 %) patients had favorable outcomes (modified Rankin scale score [mRS], 0-2) during the follow-up period (mean, 30 months; range, 6-54 months). Two patients died: one from initial subarachnoid hemorrhage and the other from intracerebral hemorrhage due to underlying Moyamoya disease. Post-treatment angiograms showed complete occlusion in nine aneurysms, residual neck in 11 aneurysms and residual sac in five aneurysms. Follow-up angiograms were available at least once between 5 to 34 months (mean, 16 months) in 21 patients. Nineteen patients showed improved or stable states (complete occlusion, n = 17; residual neck, n = 2). Major recurrences occurred in two BTAs (9.5 %). Those two major recurrent aneurysms had been large-sized aneurysms at the initial coiling procedure. Both showed not only coil compaction but also progressive growth to giant-sized aneurysms and intra-aneurysmal thrombus formation at the Y-stent coiling as a third-time treatment.
Y-stent coiling using two closed-cell stents is a safe and durable treatment option for wide-necked BTA, but may have limited efficacy for large/giant sized and thrombosed aneurysms.
本研究旨在评估使用两个闭合型支架的Y形双支架辅助（Y支架）弹簧圈栓塞术治疗宽颈基底动脉尖动脉瘤（BTA）的临床和血管造影结果。
共有25例患者接受了使用两个闭合型支架的Y支架弹簧圈栓塞术，其中18例（3例破裂）BTA为首次治疗，2例BTA为再次治疗，5例宽颈BTA为第三次治疗。对临床和血管造影结果进行了回顾性评估。
与治疗相关的并发症有3例（12.0%）血栓栓塞性梗死，原因是2例急性支架内血栓形成和1例栓塞。22例（88%）患者在随访期间（平均30个月；范围6 - 54个月）预后良好（改良Rankin量表评分[mRS]，0 - 2）。2例患者死亡：1例死于初始蛛网膜下腔出血，另1例死于潜在烟雾病导致的脑出血。治疗后的血管造影显示9个动脉瘤完全闭塞，11个动脉瘤有残留颈，5个动脉瘤有残留囊。21例患者在5至34个月（平均16个月）之间至少进行了一次随访血管造影。19例患者显示病情改善或稳定（完全闭塞，17例；残留颈，2例）。2例BTA（9.5%）发生主要复发。这两个主要复发的动脉瘤在初始弹簧圈栓塞术时为大型动脉瘤。作为第三次治疗，在Y支架弹簧圈栓塞术时，两者均不仅出现弹簧圈压缩，而且逐渐发展为巨大型动脉瘤并形成瘤内血栓。
使用两个闭合型支架的Y支架弹簧圈栓塞术是治疗宽颈BTA的一种安全且持久的治疗选择，但对于大型/巨大型和血栓形成的动脉瘤可能疗效有限。
