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支架辅助弹簧圈栓塞治疗未破裂大脑中动脉动脉瘤的应用

Stent-assisted coil embolization of unruptured middle cerebral artery aneurysms using LVIS Jr. stents.

机构信息

Department of Neurosurgery, Juntendo University, Faculty of Medicine, Japan.

Department of Neurosurgery, Juntendo University, Faculty of Medicine, Japan.

出版信息

J Clin Neurosci. 2020 Oct;80:87-91. doi: 10.1016/j.jocn.2020.07.070. Epub 2020 Aug 17.

Abstract

Authors reported the anatomical and clinical results of the stent assisted coiling (SAC) of unruptured middle cerebral artery (MCA) aneurysms using Low-profile Visualized Intraluminal Support Junior (LVIS Jr.). Forty-seven MCA aneurysms in 46 patients were the subjects of this study. The mean aneurysm size, neck width were 4.5 ± 1.8 mm, 3.0 ± 1.0 mm, respectively. Immediate anatomical outcomes were class Ⅰ in 31 (65.0%), class Ⅱ in 5 (10.6%) and class III in 11 (23.4%) patients according to Raymond-Roy classification. The latest anatomical outcomes were class Ⅰ in 33 (86.8%), class Ⅱ in 2 (5.3%) and class III in 3 (7.9%) patients. The change of aneurysm obliteration status were unchanged in 27 (71.0%), improved in 9 (23.7%) and worsen in 2 (5.3%). There were no recurrence necessitating additional treatment. Two patients suffered from angiographically evident in-stent thrombosis, but their clinical outcomes remain good. The modified Rankin scale at discharge were 0 in 45 patients, 1 in 1 patient. No patient showed clinical worsening during the clinical follow-up period at outpatient clinic (mean, 27.4 months). SAC of unruptured MCA aneurysms using LVIS Jr. provide safe and durable effect with high complete obliteration rate recurrence rate.

摘要

作者报告了使用 Low-profile Visualized Intraluminal Support Junior(LVIS Jr.)支架辅助弹簧圈栓塞(SAC)未破裂大脑中动脉(MCA)动脉瘤的解剖和临床结果。本研究共纳入 46 例患者的 47 个 MCA 动脉瘤。平均动脉瘤大小、瘤颈宽度分别为 4.5±1.8mm、3.0±1.0mm。根据 Raymond-Roy 分类,即刻解剖学结果为Ⅰ级 31 例(65.0%),Ⅱ级 5 例(10.6%),Ⅲ级 11 例(23.4%)。最新的解剖学结果为Ⅰ级 33 例(86.8%),Ⅱ级 2 例(5.3%),Ⅲ级 3 例(7.9%)。动脉瘤闭塞状态无变化 27 例(71.0%),改善 9 例(23.7%),恶化 2 例(5.3%)。无需要额外治疗的复发。2 例患者发生影像学证实的支架内血栓形成,但临床结局良好。出院时改良 Rankin 量表评分为 0 分 45 例,1 分 1 例。在门诊随访期间(平均 27.4 个月),无患者出现临床恶化。使用 LVIS Jr. 对未破裂 MCA 动脉瘤进行 SAC 可获得安全且持久的效果,完全闭塞率高,复发率低。

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