Brasiliense Leonardo B C, Yoon Jang W, Orina Josiah N, Miller David A, Tawk Rabih G, Hanel Ricardo A
Departments of *Neurologic Surgery and ‡Radiology at Mayo Clinic, Jacksonville, Florida; §Lyerly Neurosurgery, Baptist Health, Jacksonville, Florida.
Neurosurgery. 2016 Feb;78(2):200-7. doi: 10.1227/NEU.0000000000001161.
Wide-necked anterior communicating artery aneurysms represent a subset of lesions with challenging endovascular treatment despite new endoluminal and intrasaccular devices.
To assess the long-term clinical and angiographic outcomes of stent-assisted embolization for wide-necked anterior communicating artery aneurysms.
Between March 2008 and March 2014, 32 patients with unruptured wide-necked AComm aneurysms were treated using stent-assisted embolization. The Glasgow Outcome Scale was reviewed at the time of discharge and at latest follow-up. Ischemic and hemorrhagic events were also recorded and analyzed. Aneurysm occlusion was evaluated post-intervention and on subsequent follow-up evaluations.
Successful stent deployment was achieved in all cases, but in 1 patient the coils could not be contained inside the aneurysm, and the procedure was aborted without complications. The distal segment of the stent was positioned in the ipsilateral A2 in 16 patients, in the contralateral A2 in 15 patients, and in the contralateral A1 in 1 patient. There were no periprocedural thromboembolic or hemorrhagic complications. The rate of major complications was 6%. One patient developed intracranial hemorrhage related to antiplatelet therapy and another had ischemic events due to in-stent stenosis. Angiographic follow-up was available for 26 aneurysms and during a mean follow-up of 22 months, 81% of the lesions were completely occluded and 8% had a small residual neck. The retreatment rate for residual aneurysms was 3%.
Our long-term results suggest that stent-assisted embolization for anterior communicating artery aneurysms may be considered an excellent treatment option with an adequate combination of safety profile and effectiveness.
尽管有新的腔内和囊内装置，但宽颈前交通动脉瘤是血管内治疗具有挑战性的一类病变。
评估支架辅助栓塞治疗宽颈前交通动脉瘤的长期临床和血管造影结果。
2008年3月至2014年3月，32例未破裂的宽颈前交通动脉瘤患者接受了支架辅助栓塞治疗。出院时和最新随访时对格拉斯哥预后量表进行评估。还记录并分析了缺血性和出血性事件。干预后及随后的随访评估中对动脉瘤闭塞情况进行评估。
所有病例均成功置入支架，但1例患者的弹簧圈无法置于动脉瘤内，手术中止且无并发症。16例患者支架远端位于同侧A2段，15例位于对侧A2段，1例位于对侧A1段。围手术期无血栓栓塞或出血并发症。主要并发症发生率为6%。1例患者发生与抗血小板治疗相关的颅内出血，另1例因支架内狭窄出现缺血性事件。对26个动脉瘤进行了血管造影随访，平均随访22个月，81%的病变完全闭塞，8%有小的残余颈部。残余动脉瘤的再治疗率为3%。
我们的长期结果表明，支架辅助栓塞治疗前交通动脉瘤可被认为是一种安全与有效性充分结合的优秀治疗选择。
