Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA, USA.
J Neurointerv Surg. 2021 Aug;13(8):711-715. doi: 10.1136/neurintsurg-2020-016899. Epub 2020 Nov 17.
The transcirculation approach (TCA) for stent-assisted coiling (SAC) of intracranial aneurysms may be useful for certain wide-neck bifurcation aneurysms as well as those with acute-angle efferent branches.
To describe a multicenter experience using the TCA for SAC.
A multicenter, retrospective study (2016-2020) of aneurysm treatment using SAC via the TCA. Angiographic outcome was scored using the Raymond Scale (adequate occlusion 1 and 2), and clinical outcome was scored using a modified Rankin Scale (good outcome 0-2) RESULTS: Twenty-nine patients with 29 aneurysms were included (62.1% female; average age 61; 89.7% unruptured; 13.8% previously treated; average dome size 6.4 mm; average neck 4.4 mm). Aneurysm locations included internal carotid artery-fetal posterior cerebral artery (n=4), internal carotid artery terminus (n=4), anterior communicating artery (n=8), vertebral artery-posterior inferior cerebellar artery (n=2), and basilar tip (n=11). The TCA used communicating arteries (93.1%; average 1.6 mm), intermediate catheters (51.7%), jailing technique (62.1%), and staged procedures (10.3%). The most common stent was the Neuroform Atlas (Stryker; 69%). Immediate adequate occlusion was obtained in 75.9%, and five patients with inadequate occlusion progressed to adequate occlusion at follow-up. One (3.4%) procedural complication occurred: a watershed stroke in the setting of baseline four-vessel extracranial disease. Two patients had a poor outcome unrelated to the TCA. The majority of patients (86.4%) had a good clinical outcome. One case of in-stent stenosis due to non-compliance with medication was seen, which resolved with medication resumption.
The TCA for SAC can be performed for a variety of aneurysms with a low complication rate and good clinical outcomes.
对于某些宽颈分叉动脉瘤以及具有锐角流出分支的动脉瘤，可采用经再循环通路(transcirculation approach, TCA)的支架辅助弹簧圈栓塞术(stent-assisted coiling, SAC)。
描述采用 TCA 行 SAC 的多中心经验。
采用回顾性多中心研究（2016-2020 年），分析采用 TCA 行 SAC 治疗的患者。采用 Raymond 分级（完全闭塞 1 级和 2 级）评估血管造影结果，采用改良 Rankin 量表（改良 Rankin 量表 0-2 级为良好预后）评估临床结果。
共纳入 29 例 29 个动脉瘤患者（女性占 62.1%；平均年龄 61 岁；93.1%未破裂；13.8%为既往治疗；平均瘤颈 4.4mm；平均瘤体 6.4mm）。动脉瘤部位包括颈内动脉-胚胎型大脑后动脉（n=4）、颈内动脉终末段（n=4）、前交通动脉（n=8）、椎动脉-小脑后下动脉（n=2）和基底动脉尖（n=11）。采用再循环通路（93.1%；平均 1.6mm）、中间导管（51.7%）、血管内隔离技术（62.1%）和分期治疗（10.3%）。最常用的支架为 Neuroform Atlas（Stryker）（69%）。即刻完全闭塞率为 75.9%，5 例不完全闭塞患者在随访时进展为完全闭塞。发生 1 例（3.4%）手术并发症：在基线四血管颅外疾病的情况下出现分水岭性卒中。2 例患者预后不良与 TCA 无关。大多数患者（86.4%）临床结局良好。1 例因不遵医嘱服药导致支架内狭窄，恢复服药后狭窄缓解。
TCA 用于 SAC 治疗各种类型的动脉瘤，并发症发生率低，临床结局良好。
