采用单枚低剖面可视化腔内支撑支架辅助弹簧圈栓塞治疗大脑中动脉分叉未破裂宽颈动脉瘤。
The use of single low-profile visualized intraluminal support stent-assisted coiling in the treatment of middle cerebral artery bifurcation unruptured wide-necked aneurysm.
机构信息
Department of Neurosurgery of Changhai Hospital Affiliated to the Naval Military Medical University, Shanghai, China.
Department of Plastic Surgery of Changhai Hospital Affiliated to the Naval Military Medical University, Shanghai, China.
出版信息
Interv Neuroradiol. 2020 Aug;26(4):461-467. doi: 10.1177/1591019920901925. Epub 2020 Jan 24.
OBJECTIVE
Endovascular treatment of unruptured wide-necked aneurysms located at the middle cerebral artery bifurcation remains challenging. This study aimed to evaluate the safety and efficacy of endovascular treatment for middle cerebral artery bifurcation unruptured wide-necked aneurysms using a low-profile visualized intraluminal support (LVIS) stent.
METHODS
We retrospectively reviewed all patients with middle cerebral artery bifurcation unruptured wide-necked aneurysms treated using an LVIS device at our institution between October 2014 and December 2018. Clinical presentation, aneurysmal characteristics, technical feasibility, perioperative complications, clinical outcome, and angiographic and clinical follow-up results were evaluated.
RESULTS
Fifty-seven patients with 57 wide-necked aneurysms arising from the middle cerebral artery bifurcation were identified The technical success rate of stent deployment was 100%. Immediate postoperative angiograms showed Raymond 1 in 26 aneurysms (45.6%), Raymond 2 in 10 (17.6%), and Raymond 3 in 21 (36.8%). Perioperative complications developed in two patients (3.5%), including one procedure-related hemorrhagic event and one thromboembolic event. The follow-up angiogram was available for 47 aneurysms obtained at an average of 11.7 months (range, 5 to 49 months) after intervention; the latest follow-up angiograms revealed complete occlusion in 37 (78.7%) aneurysms, improvement in three (6.4%), stabilization in five (10.6%), and recanalization in two (4.3%). During the follow-up, one patient was found to have in-stent stenosis and two patients were found to have slow flow or occlusion of the jailed branch. All three of these patients were asymptomatic. No hemorrhagic or thromboembolic events occurred during clinical follow-up.
CONCLUSIONS
Our experience suggests that endovascular treatment of middle cerebral artery bifurcation unruptured wide-necked aneurysms with an LVIS stent is safe and effective, but the effect on branches needs to be further studied.
目的
血管内治疗位于大脑中动脉分叉处的未破裂宽颈动脉瘤仍然具有挑战性。本研究旨在评估使用低剖面可视化腔内支撑（LVIS）支架血管内治疗大脑中动脉分叉处未破裂宽颈动脉瘤的安全性和有效性。
方法
我们回顾性分析了 2014 年 10 月至 2018 年 12 月期间在我院接受 LVIS 装置治疗的大脑中动脉分叉处未破裂宽颈动脉瘤患者的所有病例。评估了临床表现、动脉瘤特征、技术可行性、围手术期并发症、临床转归以及血管造影和临床随访结果。
结果
共确定了 57 例起源于大脑中动脉分叉处的 57 个宽颈动脉瘤患者。支架置入的技术成功率为 100%。即刻术后血管造影显示，26 个动脉瘤中 Raymond 分级 1 级 26 个（45.6%），Raymond 分级 2 级 10 个（17.6%），Raymond 分级 3 级 21 个（36.8%）。2 例患者（3.5%）发生围手术期并发症，包括 1 例与手术相关的出血事件和 1 例血栓栓塞事件。47 个动脉瘤的随访血管造影在介入治疗后平均 11.7 个月（5 至 49 个月）获得，最新的随访血管造影显示完全闭塞 37 个（78.7%），改善 3 个（6.4%），稳定 5 个（10.6%），再通 2 个（4.3%）。随访期间，1 例患者发现支架内狭窄，2 例患者发现被夹闭分支的慢血流或闭塞。这 3 例患者均无症状。临床随访期间无出血或血栓栓塞事件发生。
结论
我们的经验表明，使用 LVIS 支架血管内治疗大脑中动脉分叉处未破裂宽颈动脉瘤是安全有效的，但对分支的影响需要进一步研究。
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