Samaniego Edgar A, Mendez Aldo A, Nguyen Thanh N, Kalousek Vladimir, Guerrero Waldo R, Dandapat Sudeepta, Dabus Guilherme, Linfante Italo, Hassan Ameer E, Drofa Alexander, Kouznetsov Evgueni, Leedahl David, Hasan David, Maud Alberto, Ortega-Gutierrez Santiago
Department of Neurology, Neurosurgery and Radiology, University of Iowa, Iowa, Iowa, USA.
Department of Neurology, Neurosurgery and Radiology, Boston Medical Center, Boston, Massachusetts, USA.
Interv Neurol. 2018 Apr;7(5):271-283. doi: 10.1159/000487545. Epub 2018 Apr 3.
Complex wide-neck intracranial aneurysms are challenging to treat. We report a multicenter experience using the LVIS Jr stent for "Y-stent"-assisted coiling embolization of wide-neck bifurcation aneurysms.
Seven centers provided retrospective data on patients who underwent Y-stenting. Technical complications, immediate posttreatment angiographic results, clinical outcomes, and imaging follow-up were assessed.
Thirty patients/aneurysms were treated: 15 basilar tip, 8 middle cerebral artery, 4 anterior communicating artery, 1 pericallosal, and 2 posterior inferior cerebellar artery aneurysms. The mean aneurysm size was 11 mm and the mean dome-to-neck ratio was 1.3 mm. Twenty-four aneurysms were unruptured and treated electively, and 6 were acutely ruptured. Fifty-eight LVIS Jr stents were successfully deployed without any technical issue. One pro-cedural and transient in-stent thrombosis resolved with the intravenous infusion of a glycoprotein IIb/IIIa inhibitor. Five periprocedural complications (within 30 days) occurred: 2 periprocedural neurological complications (1 small temporal stroke that presented with transient aphasia and 1 posterior cerebral artery infarct) and 3 nonneurological periprocedural complications (2 retroperitoneal hematomas, and 1 patient developed a disseminated intravascular coagulopathy). One permanent complication (3.3%) directly related to Y-stenting was reported in the patient who suffered the posterior cerebral artery infarct. Immediate complete obliteration (Raymond-Roy Occlusion Classification [RROC] I-II) was achieved in 26 cases (89.6%). Twenty-four patients had clinical and imaging follow-up (mean 5.2 months). Complete angiographic occlusion (RROC I-II) was observed in 23 patients (96%). A good functional outcome with a modified Rankin Scale score ≤2 was achieved in 26 cases.
In this multicenter case series, Y-stent-assisted coiling of wide-neck aneurysms with the LVIS Jr device was feasible and relatively safe. Follow-up imaging demonstrated very low recanalization rates.
复杂宽颈颅内动脉瘤的治疗具有挑战性。我们报告了一项多中心经验，使用LVIS Jr支架进行“Y形支架”辅助弹簧圈栓塞治疗宽颈分叉动脉瘤。
七个中心提供了接受Y形支架置入术患者的回顾性数据。评估了技术并发症、治疗后即刻血管造影结果、临床结局和影像学随访情况。
共治疗30例患者/动脉瘤：15例基底动脉尖部、8例大脑中动脉、4例前交通动脉、1例胼周动脉和2例小脑后下动脉动脉瘤。动脉瘤平均大小为11mm，平均瘤颈比为1.3mm。24例动脉瘤未破裂，接受择期治疗，6例为急性破裂。成功置入58枚LVIS Jr支架，无任何技术问题。1例术中短暂性支架内血栓形成经静脉输注糖蛋白IIb/IIIa抑制剂后缓解。发生5例围手术期并发症（30天内）：2例围手术期神经并发症（1例小的颞叶卒中伴短暂性失语，1例大脑后动脉梗死）和3例非神经围手术期并发症（2例腹膜后血肿，1例患者发生弥散性血管内凝血）。报告1例与Y形支架置入直接相关的永久性并发症（3.3%），该患者发生大脑后动脉梗死。26例（89.6%）实现即刻完全闭塞（雷蒙德-罗伊闭塞分级[RROC] I-II级）。24例患者进行了临床和影像学随访（平均5.2个月）。23例（96%）观察到血管造影完全闭塞（RROC I-II级）。26例患者获得改良Rankin量表评分≤2的良好功能结局。
在这个多中心病例系列中，使用LVIS Jr装置进行Y形支架辅助弹簧圈栓塞治疗宽颈动脉瘤是可行且相对安全的。随访影像学显示再通率极低。
