Brassel Friedhelm, Grieb Dominik, Meila Dan, Schlunz-Hendann Martin, Greling Björn, Melber Katharina
Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany.
Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany.
J Neurointerv Surg. 2017 Sep;9(9):854-859. doi: 10.1136/neurintsurg-2016-012571. Epub 2016 Aug 24.
To determine the safety and effectiveness of a new low-profile, laser-cut, closed-cell stent system in the treatment of complex intracranial aneurysms.
A total number of 43 patients with complex intracranial aneurysms were treated using 60 Acandis Acclino stent systems (follow-up 2012-2016; mean 11 months). 36 patients presented with wide-necked intracranial aneurysms, dissecting aneurysms were seen in 7 patients. 39 patients received stent-assisted coiling. We analyzed demographic data and follow-up results.
Sixty stents were successfully deployed. In one paraophthalmic internal carotid artery aneurysm the stent could not be placed. Thirty-three wide necked aneurysms were treated by single or multiple stent-assisted coiling. Complete occlusion was achieved in 31 of those cases (94% Raymond-Roy occlusion classification, RROC 1). Two patients showed stable residual aneurysmal filling (RROC 3). In three wide-necked aneurysms, sole stenting was the preferred treatment. For dual stent-assisted procedures the kissing-Y stenting technique was successfully performed in 11 aneurysms. In all dissecting aneurysms constructive therapy with stenting and preservation of the affected parent artery was achieved. Additional subsequent coil embolization was intentionally planned and successfully performed in 6 of the 7 dissecting aneurysms. The overall directly procedure-related complication rate was 7%, including one death.
Endovascular treatment of complex intracranial aneurysms using Acclino stents is a feasible and safe procedure with low complication rates. Even severe cases can be treated among others using the kissing-Y stenting technique, with good mid-term results.
确定一种新型低轮廓、激光切割、闭孔支架系统治疗复杂颅内动脉瘤的安全性和有效性。
使用60个Acandis Acclino支架系统治疗了43例复杂颅内动脉瘤患者（随访时间为2012 - 2016年；平均11个月）。36例患者为宽颈颅内动脉瘤，7例为夹层动脉瘤。39例患者接受了支架辅助弹簧圈栓塞治疗。我们分析了人口统计学数据和随访结果。
成功植入60个支架。在1例眶内段颈内动脉瘤中无法放置支架。33例宽颈动脉瘤采用单枚或多枚支架辅助弹簧圈栓塞治疗。其中31例实现了完全闭塞（Raymond - Roy闭塞分级94%，RROC 1）。2例患者的动脉瘤残余充盈稳定（RROC 3）。在3例宽颈动脉瘤中，单纯支架置入是首选治疗方法。对于双支架辅助手术，11例动脉瘤成功实施了“亲吻 - Y”支架置入技术。在所有夹层动脉瘤中，通过支架置入和保留受累母动脉实现了建设性治疗。7例夹层动脉瘤中有6例有意计划并成功实施了后续弹簧圈栓塞。总的直接手术相关并发症发生率为7%，包括1例死亡。
使用Acclino支架对复杂颅内动脉瘤进行血管内治疗是一种可行且安全的手术，并发症发生率低。即使是严重病例，也可采用“亲吻 - Y”支架置入技术等进行治疗，中期效果良好。
