Chen Linhui, Zheng Chaobo, Wu Jiong, Gong Jie, Gao Yuhai, Wan Shu
Brain Center Department, Zhejiang Hospital, Hangzhou, China.
Front Neurol. 2020 Dec 3;11:589689. doi: 10.3389/fneur.2020.589689. eCollection 2020.
Self-expanding devices, such as the Enterprise VRD (EP-VRD) have widely used for stent-assisted coiling treatment in wided-necked aneuryms while some thromboembolic complications were reported due to its incomplete stent apposition (ISA). We report our experiences on the novel Enterprise2 (EP-VRD2) stent in the treatment of intracranial and cranial cervical junction aneurysms. Twenty-five consecutive patients with intracranial or cranial cervical junction aneurysms were treated with EP-VRD2 stents retrospectively collected in our institution. We use the 'jailing' technique in all cases and deployed the stent by using pushing over the outer curve technique. The 3- or 6-monthS follow-up was done regularly by DSA. Twenty-five EP-VRD2 stents were implanted to treat 21 aneurysms at the siphon segment of internal carotid artery (ICA), one at the petrous segment, two at the cervical segment, one at the verteral artery with five accompanied with stenosis. Two patients had kinking during the procedure and were solved by microwire or microcatheter massaging. Four patients with a larger arc angle and a smaller radius of the parent vessel was detected ISA. No patient underwent the ischemic event after the operation. Twenty-three of 25 patients were evaluated after 3- or 6-months by DSA, 22 showed complete occlusion (RROC1), one slight re-stenosis in the follow-up within those five patients with stenosis. A length of 23 mm seemed associated with ISA ( < 0.01). The EP-VRD2 performed well in our small patient series; however, ISA could still occur with a sharp angle of the parent vessel.
自膨式装置,如Enterprise VRD(EP-VRD),已广泛应用于宽颈动脉瘤的支架辅助栓塞治疗,但因其支架贴壁不完全(ISA)而导致一些血栓栓塞并发症的报道。我们报告了新型Enterprise2(EP-VRD2)支架治疗颅内和颅颈交界动脉瘤的经验。回顾性收集了在我院接受EP-VRD2支架治疗的25例连续的颅内或颅颈交界动脉瘤患者。所有病例均采用“套入”技术,并通过外弯推送技术置入支架。定期通过数字减影血管造影(DSA)进行3或6个月的随访。共植入25枚EP-VRD2支架,治疗颈内动脉(ICA)虹吸段动脉瘤21例、岩骨段1例、颈段2例、椎动脉1例,其中5例伴有狭窄。2例患者在手术过程中出现支架扭曲,通过微导丝或微导管按摩解决。4例母血管弧度较大、半径较小的患者检测到ISA。术后无患者发生缺血事件。25例患者中的23例在3或6个月后通过DSA进行评估,22例显示完全闭塞(RROC1),5例狭窄患者中有1例在随访中出现轻度再狭窄。23mm的长度似乎与ISA有关(<0.01)。在我们的小样本患者系列中,EP-VRD2表现良好;然而,母血管呈锐角时仍可能发生ISA。