Department of Neurosurgery, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Medical School and Hospital, Daejeon, Republic of Korea.
Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong- gil 38, Sacheon-myeon, Gangneung, Gangwon-do, Republic of Korea.
Neuroradiology. 2020 Jul;62(7):883-890. doi: 10.1007/s00234-020-02411-1. Epub 2020 Apr 4.
We report the long-term results of a modified stent-assisted coil embolization technique using the far proximal part of a self-expanding open-cell stent. The technique was used to cover the neck of the aneurysm while simultaneously preserving the branches of the distal internal carotid artery in patients with aneurysms of the posterior communicating (Pcom) and anterior choroidal arteries (AchA).
We performed a retrospective review of the prospectively maintained databases at two tertiary neurosurgical centers to identify all patients who underwent embolization of Pcom or AchA aneurysms using this technique between January 2014 and July 2019. Postoperative and follow-up clinical and radiological results for initial (n = 16) or re-do (n = 4) embolizations were analyzed.
We identified 19 patients with 20 (16 Pcom and 4 AchA) unruptured (n = 19) or ruptured (n = 1) aneurysms. Eighteen among 20 stents (90.0%) were deployed successfully, and complete occlusions were initially attained in 18 aneurysms (90.0%). At follow-up examinations 8 to 56 months later, 6 of 14 aneurysms (42.8%) showed neck remnants. All of the branches were saved and no thromboembolic event, rupture, or sequelae were noted during or after the procedures.
These results suggest that this modified stent-assisted technique is a feasible and reasonable alternative to conventional stent deployment for coil embolization of wide-necked sidewall aneurysms in the distal ICA.
我们报告了一种改良的支架辅助线圈栓塞技术的长期结果，该技术使用自膨开环支架的远近端部分覆盖动脉瘤颈部，同时保留远端颈内动脉的分支。该技术适用于后交通（Pcom）和脉络膜前动脉（AchA）动脉瘤患者。
我们对两个三级神经外科中心的前瞻性维护数据库进行了回顾性分析，以确定 2014 年 1 月至 2019 年 7 月期间使用该技术栓塞 Pcom 或 AchA 动脉瘤的所有患者。分析了初始（n=16）或再治疗（n=4）栓塞的术后和随访临床及影像学结果。
我们确定了 19 例患者的 20 个（16 个 Pcom 和 4 个 AchA）未破裂（n=19）或破裂（n=1）动脉瘤。20 个支架中的 18 个（90.0%）成功植入，18 个动脉瘤（90.0%）最初达到完全闭塞。在 8 至 56 个月的随访检查中，14 个动脉瘤中有 6 个（42.8%）显示颈部残留。所有分支均得以保留，且在手术过程中和手术后均未发生血栓栓塞事件、破裂或后遗症。
这些结果表明，与传统支架部署相比，该改良的支架辅助技术是一种可行且合理的选择，可用于治疗远端颈内动脉侧壁宽颈动脉瘤的线圈栓塞。
