Murchison Andrew G, Young Victoria, Djurdjevic Tanja, Cellerini Martino, Corkill Rufus, Küker Wilhelm
Department of Neuroradiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.
Neuroradiology. 2018 Jul;60(7):735-744. doi: 10.1007/s00234-018-2020-6. Epub 2018 Apr 11.
Endovascular stents are widely used for the elective treatment of cerebral aneurysms. Acute stenting is performed in the management of dissections, pseudo-aneurysms, broad-based aneurysms or as a 'bail out' measure after coil migration. The purpose of this study is to review the safety of using stents in acute subarachnoid haemorrhage.
The stent registry of our institution was reviewed for procedures in patients with acute subarachnoid haemorrhage. Imaging studies were reviewed on the hospital's PACS system and the patients' notes were retrieved to assess complications and clinical outcomes. Procedures were analysed according to the type of stent, treatment indication, antiplatelet regime, complications and outcomes.
Between 2008 and 2016, 51 stents were placed during 50 stenting procedures in 49 patients with acute subarachnoid haemorrhage. This included 24 patients with saccular aneurysms, 10 with blister aneurysms, 10 dissections and five fusiform aneurysms. Stents were deployed in 'bail out' situations on eight occasions. In six cases, flow-diverting stents were used. Eighteen patients (37%) in the cohort suffered a stroke. Nine patients (18%) suffered persistent clinical deficits as a result of the stenting procedure, all but one of which occurred within 24 h. Two patients had a transient ischaemic episode, and there was evidence of asymptomatic ischaemia on imaging in four cases (8%). Five patients died, three (6%) as a result of procedural complications. Twelve patients (25%) required a further embolisation procedure.
The use of stents in acute subarachnoid haemorrhage incurs a considerable complication risk and should be reserved for exceptional circumstances.
血管内支架广泛用于脑动脉瘤的择期治疗。急性支架置入术用于夹层动脉瘤、假性动脉瘤、宽基底动脉瘤的治疗，或作为弹簧圈移位后的“补救”措施。本研究旨在回顾急性蛛网膜下腔出血患者使用支架的安全性。
回顾我院机构的支架登记资料，纳入急性蛛网膜下腔出血患者的手术记录。通过医院的PACS系统查看影像学研究，并检索患者病历以评估并发症和临床结局。根据支架类型、治疗指征、抗血小板治疗方案、并发症和结局对手术进行分析。
2008年至2016年期间，49例急性蛛网膜下腔出血患者接受了50次支架置入手术，共置入51枚支架。其中包括24例囊状动脉瘤患者、10例泡状动脉瘤患者、10例夹层动脉瘤患者和5例梭形动脉瘤患者。有8次在“补救”情况下置入支架。6例使用了血流导向支架。该队列中有18例患者（37%）发生了卒中。9例患者（18%）因支架置入手术出现持续性临床功能缺损，除1例之外，均发生在24小时内。2例患者出现短暂性缺血发作，4例（8%）影像学检查有无症状性缺血证据。5例患者死亡，3例（6%）死于手术并发症。12例患者（25%）需要进一步进行栓塞手术。
急性蛛网膜下腔出血患者使用支架会带来相当大的并发症风险，应仅用于特殊情况。
