Lu Jun, Wang Daming, Liu Jiachun, Wang Lijun, Qi Peng
Department of Neurosurgery, Beijing Hospital, Beijing 100730, China.
Department of Neurosurgery, Beijing Hospital, Beijing 100730, China; Email:
Zhonghua Wai Ke Za Zhi. 2015 Jul 1;53(7):538-42.
To evaluate the short-term outcome of single stenting technique for unruptured, wide-necked, tiny aneurysms of the anterior circulation.
Eleven unruptured, wide-necked, tiny aneurysms of the anterior circulation were treated by a single stent deployed in the parent artery between January 2008 and July 2013 in Department of Neurosurgery in Beijing Hospital. The maximum diameter of the aneurysms ranged from 2.0 to 3.0 mm, mean (2.4 ± 0.4) mm, and the dome-to-neck ratios were all ≤ 1.2. The locations were clinoid segment of internal carotid artery (n=2), posterior communicating artery origin (n=4), anterior choroidal artery origin (n=2) and middle cerebral artery bifurcation (n=3). All internal carotid aneurysms were located in the medial and/or ventral wall of the internal carotid artery. The rate of aneurysm obliteration and rupture during follow-up was obtained by repeat angiography and clinic or telephone interview respectively.
Sole stent placement in the parent artery was intentionally performed for nine aneurysms, while attempt of coiling after stent deployment for the other two aneurysms failed due to unsuccessful microcatherization. Ten stents were successfully deployed, of which one was used to treat two tandem lesions simultaneously. Only one aneurysm became smaller immediately postprocedure. No perioperative complications occurred. Angiographic follow-up after a mean period of (13 ± 6) months (range 8-24 months) revealed that 8 aneurysms did no change in size, 2 became smaller and only one was totally occluded. Asymptomatic in-stent stenosis of the parent artery was found in all 3 shrinking or occluded aneurysms. No aneurysm rupture was observed in the clinical follow-up.
For those unruptured, wide-necked, tiny aneurysms arising at branching sites in the anterior circulation, single stenting technique seems to be a safe alternative treatment, while the short-term rate of aneurysm occlusion is low.
评估单支架技术治疗前循环未破裂、宽颈、微小动脉瘤的短期疗效。
2008年1月至2013年7月，北京医院神经外科采用单支架植入载瘤动脉的方法治疗11例前循环未破裂、宽颈、微小动脉瘤。动脉瘤最大直径2.0～3.0mm，平均（2.4±0.4）mm，瘤颈比均≤1.2。病变部位：颈内动脉床突段（2例）、后交通动脉起始部（4例）、脉络膜前动脉起始部（2例）、大脑中动脉分叉处（3例）。所有颈内动脉瘤均位于颈内动脉内侧和/或腹侧壁。随访期间动脉瘤闭塞率和破裂率分别通过重复血管造影和临床或电话随访获得。
9例动脉瘤单纯行载瘤动脉内支架植入，另外2例支架植入后因微导管置入失败而未能行弹簧圈栓塞。成功植入10枚支架，其中1枚同时治疗2个串联病变。术后仅1例动脉瘤即刻缩小。无围手术期并发症发生。平均（13±6）个月（8～24个月）的血管造影随访显示，8例动脉瘤大小无变化，2例缩小，仅1例完全闭塞。所有3例缩小或闭塞的动脉瘤均发现载瘤动脉无症状性支架内狭窄。临床随访未观察到动脉瘤破裂。
对于前循环分支部位的未破裂、宽颈、微小动脉瘤，单支架技术似乎是一种安全的替代治疗方法，但动脉瘤短期闭塞率较低。
