Zhu Deyuan, Fang Yibin, Yang Pengfei, Zhang Ping, Chen Lei, Xu Yi, Hong Bo, Huang Qinghai, Liu Jian-Min
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
World Neurosurg. 2017 Aug;104:729-735. doi: 10.1016/j.wneu.2017.03.092. Epub 2017 Mar 27.
To evaluate the safety and efficacy of overlapped stenting for blood blister-like aneurysms (BBAs) and to compare the outcomes between Low-profile Visualized Intraluminal Support (LVIS) and non-LVIS stents.
A retrospective review of the aneurysm database identified 37 patients with intracranial carotid artery BBAs treated by overlapped stenting in our institution from June 2013 to June 2016. The clinical characteristics and angiographic results were reviewed.
Overlapped stenting combined with coiling were applied in 37 BBAs, including LVIS stents in 18 cases and non-LVIS stents in 19. For the LVIS group, angiographic results at 3-24 months were complete occlusion in 15 cases (83.3%), improved in 2 cases (11.1%), and recanalized in 1 case (5.6%). The modified Rankin Scale scores at 3-36 months' follow-up were 0-2 in 15 cases (83.3%) and 3-6 in 3 cases (16.7%). For the non-LVIS group, angiographic results at 3-46 months were complete occlusion in 12 cases (63.2%) and recanalized in 7 cases (36.8%). Clinical outcomes at 6-58 months were modified Rankin Scale scores of 0-2 in 17 cases (89.5%) and 3-6 in 2 cases (10.5%). Use of the LVIS stent was less likely to result in recanalization (odds ratio 0.10, 95% confidence interval 0.01-0.93, P = 0.042) than the non-LVIS stent. The LVIS group had a lower average number of stents than did the non-LVIS group (2.2 vs. 2.6, P = 0.016). In terms of complication rate (11.1% vs. 5.3%, P = 0.604), good outcome rate (83.3% vs. 89.5%, P = 0.660), and immediate angiographic result (P = 0.424), no statistically significant difference between the 2 groups was found.
Overlapped LVIS stenting combined with coiling is feasible and safe for BBAs. Overall, the LVIS stent provided less risk of BBA recurrence compared with the non-LVIS stent and did not increase the risk of procedure-related complications.
评估重叠支架置入术治疗血泡样动脉瘤（BBAs）的安全性和有效性，并比较低轮廓可视化腔内支撑（LVIS）支架与非LVIS支架的治疗效果。
回顾性分析动脉瘤数据库，纳入2013年6月至2016年6月在本机构接受重叠支架置入术治疗的37例颅内颈内动脉BBAs患者。回顾其临床特征和血管造影结果。
37个BBAs采用重叠支架置入术联合弹簧圈栓塞治疗，其中18例使用LVIS支架，19例使用非LVIS支架。LVIS组中，3 - 24个月时血管造影结果显示15例（83.3%）完全闭塞，2例（11.1%）改善，1例（5.6%）再通。3 - 36个月随访时改良Rankin量表评分为0 - 2分的有15例（83.3%），3 - 6分的有3例（16.7%）。非LVIS组中，3 - 46个月时血管造影结果显示12例（63.2%）完全闭塞，7例（36.8%）再通。6 - 58个月时临床结果显示改良Rankin量表评分为0 - 2分的有17例（89.5%），3 - 6分的有2例（10.5%）。与非LVIS支架相比，使用LVIS支架再通的可能性较小（优势比0.10，95%置信区间0.01 - 0.93，P = 0.042）。LVIS组的平均支架数量低于非LVIS组（2.2比2.6，P = 0.016）。在并发症发生率（11.1%比5.3%，P = 0.604）、良好预后率（83.3%比89.5%，P = 0.660）和即刻血管造影结果（P = 0.424）方面，两组间未发现统计学显著差异。
重叠LVIS支架置入术联合弹簧圈栓塞治疗BBAs是可行且安全有效的。总体而言，与非LVIS支架相比，LVIS支架降低了BBAs复发的风险，且未增加手术相关并发症的风险。
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