Fang Chun, Liu Chuan-Sen, Xiao Ya-Ping, Zhao Mei, Zhang Jian-Min, Li Ming-Hua, Zhu Yue-Qi
Department of Neurosurgery, the Second Affiliated Hospital, Medical School of Zhe Jiang University, China Department of Neuro-Interventional Radiology, Shanghai East Hospital, Medical School of Tong Ji University, China.
Department of Neuro-Interventional Radiology, Shanghai East Hospital, Medical School of Tong Ji University, China.
Interv Neuroradiol. 2015 Jun;21(3):317-24. doi: 10.1177/1591019915581993. Epub 2015 May 13.
The purpose of this article is to evaluate the efficacy and safety of covered stent implantation for large intracranial aneurysms treated with stent-assisted coiling.
Seven patients with a cerebral aneurysm were selected for this study. The aneurysms were located at the cavernous segment of the internal carotid artery in three cases, the supraclinoid segment in two and the vertebrobasilar junction in one. Aneurysm diameter was 10-25 mm. Mass effect symptoms occurred in six patients, epistaxis in one and subarachnoid hemorrhage in one. All patients underwent endovascular reconstruction with stent-assisted coiling and a covered stent. Five had undergone conventional endovascular embolization with stent-assisted coiling three to six months previously; the covered stent was then navigated through the existing stent and deployed to cover the aneurysm neck. In two cases, the covered stent was deployed after stent-assisted coiling in a single procedure.
Angiography showed that all aneurysms were excluded from the circulation and parent arteries were preserved. No technical adverse events occurred. At the one- to two-year follow-up, complete resolution of clinical symptom had occurred in six patients and partial resolution in one. No recurrent aneurysm filling and no hemodynamic stenosis was observed.
Endovascular reconstruction combining a covered stent with stent-assisted coiling could be an effective and safe strategy for the treatment of large cerebral aneurysms.
本文旨在评估覆膜支架植入术在支架辅助弹簧圈栓塞治疗大型颅内动脉瘤中的有效性和安全性。
本研究选取了7例脑动脉瘤患者。动脉瘤位于颈内动脉海绵窦段3例，鞍上段2例，椎基底动脉交界处1例。动脉瘤直径为10 - 25毫米。6例患者出现占位效应症状，1例鼻出血，1例蛛网膜下腔出血。所有患者均接受了支架辅助弹簧圈栓塞及覆膜支架的血管内重建术。5例患者在3至6个月前曾接受过传统的支架辅助弹簧圈栓塞术；然后将覆膜支架通过现有的支架送入并展开以覆盖动脉瘤颈部。2例患者在单次手术中于支架辅助弹簧圈栓塞术后植入覆膜支架。
血管造影显示所有动脉瘤均被排除在血液循环之外，载瘤动脉得以保留。未发生技术相关不良事件。在1至2年的随访中，6例患者临床症状完全缓解，1例部分缓解。未观察到动脉瘤复发充盈及血流动力学狭窄。
覆膜支架与支架辅助弹簧圈栓塞相结合的血管内重建术可能是治疗大型脑动脉瘤的一种有效且安全的策略。
