Department of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.
J Neurointerv Surg. 2019 Jun;11(6):591-597. doi: 10.1136/neurintsurg-2018-014488. Epub 2019 Jan 23.
Low profile braided stents have facilitated the endovascular treatment of broad-based intracranial aneurysms.
Between 2013 and June 2018, we attempted 104 Leo baby stent placements in 101 patients. Locations were the anterior communicating artery (AcomA) (37 aneurysms, 35.6%), middle cerebral artery (MCA) bifurcation (29 aneurysms, 27.9%) and basilar artery (23aneurysms, 22.1%). Mean neck size was 4.9 mm (2.2-8.2). 60 aneurysms were incidental, 31 of 37 recurrent aneurysms had ruptured before.
Stent deployment was successful in 89.4% of cases. Common reasons for failure were inability to access the parent artery (n=5) or to deploy the stent across the aneurysm neck (n=4). Two patients had poor outcomes within 24 hours. One patient developed a brain hemorrhage caused by guide wire perforation (MRS 5), the other an early thrombotic stent occlusion (MRS 4). No patient died. Nine (8.7%) patients experienced transient neurological deficits with ischemic lesions on diffusion weighted imaging (DWI). Initially Raymond-Roy class 1 occlusion was achieved in 23 aneurysms (24.7%), class 2 occlusion in 40 (43%), class 3a occlusion in 14 (15.0%), and 3b occlusion in 16 aneurysms (17.2%). Follow-up imaging in 87 patients showed stable or improved occlusion grades in 76%. Six patients required retreatment while the rest were managed conservatively. Four delayed stent occlusions occurred in three patients, with severe morbidity in one patient (MRS 5). There were no aneurysm ruptures or deaths.
Stent assisted treatment of broad-based aneurysms with the Leo baby stent is safe and effective. The frequency of delayed thrombotic complications is low and similar to other stents.
低剖面编织支架使宽颈颅内动脉瘤的血管内治疗成为可能。
2013 年至 2018 年 6 月，我们尝试在 101 例患者中放置 104 个 Leo baby 支架。部位为前交通动脉（AcomA）（37 个动脉瘤，35.6%）、大脑中动脉（MCA）分叉（29 个动脉瘤，27.9%）和基底动脉（23 个动脉瘤，22.1%）。平均颈宽为 4.9mm（2.2-8.2）。60 个动脉瘤为偶然发现，37 个复发动脉瘤中有 31 个在破裂前曾破裂。
支架置入成功率为 89.4%。失败的常见原因包括无法进入载瘤动脉（n=5）或无法将支架穿过动脉瘤颈部（n=4）。2 例患者在 24 小时内预后不良。1 例患者因导丝穿孔导致脑出血（MRS 5），另 1 例患者发生早期血栓性支架闭塞（MRS 4）。无患者死亡。9 例（8.7%）患者出现短暂性神经功能缺损，弥散加权成像（DWI）显示缺血性病变。最初，23 个动脉瘤（24.7%）达到 Raymond-Roy 1 级闭塞，40 个动脉瘤（43%）达到 2 级闭塞，14 个动脉瘤（15.0%）达到 3a 级闭塞，16 个动脉瘤（17.2%）达到 3b 级闭塞。87 例患者的随访影像学显示 76%的闭塞程度稳定或改善。6 例患者需要再次治疗，其余患者保守治疗。3 例患者发生 4 例迟发性支架闭塞，1 例患者严重致残（MRS 5）。无动脉瘤破裂或死亡。
使用 Leo baby 支架治疗宽颈动脉瘤是安全有效的。迟发性血栓并发症的发生率较低，与其他支架相似。
