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[编织型密网支架治疗颅内宽颈分叉部动脉瘤的疗效分析]

[Effect analysis of treating intracranial wide-neck bifurcation aneurysms through Woven EndoBridge].

作者信息

Yang F Y, Liu J M, Lyu Q, Wang G, Tang Y C, Du S Y, Gao X, Liang G B

机构信息

Department of Neurosurgery, the Northern Theater General Hospital, Shenyang 110000, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2022 Sep 1;60(9):831-837. doi: 10.3760/cma.j.cn112139-20220531-00246.

Abstract

To explore the clinical effect of Woven EndoBridge (WEB) in the treatment of wide-neck bifurcation aneurysms. The clinical and imaging data of 11 patients with intracranial wide-neck bifurcation aneurysms treated by WEB alone at Department of Neurosurgery of the Northern Theater General Hospital from September 2017 to May 2018, were retrospectively analyzed. The patients were 7 males and 4 females, aged (54±11) years (ranged from 31 to 66 years). The aneurysms of 5 patients were located in the anterior communicating artery, 3 in the top of the basilar artery, and 3 in the bifurcation of the middle cerebral artery. The intraoperative and postoperative conditions of the patients were recorded, and the degree of aneurysm embolization was evaluated by WEB embolization aneurysm occlusion scale (WOS). The intraoperative WEB release of all the 11 patients was good, with 3 cases of WOS grade A, 1 of grade B and 7 of grade C, with no intraoperative acute complications occurring. The imaging follow-up was not carried out in 1 patient due to economic reason, and the clinical follow-up was good until 3 years after the operation; 10 patients were followed up by imaging for 6 months to 3 years, and no postoperative complications occurred in the target treatment area. Among the 2 patients with WOS grade A and 1 patient with grade B during operation, according to the postoperative follow-up, all were WOS grade A; among the 7 patients with WOS grade C during operation, 4 were still of grade C and 3 were of grade D according to the follow-up. Among the 3 patients with WOS grade D, 1 patient received secondary embolization due to poor recurrence morphology, unstable hemodynamics and high possibility of rupture of aneurysm, stent assisted coil embolization was adopted, with good immediate effect; the other 2 cases had recurrent aneurysms, but the aneurysms had good morphology and stable hemodynamics, therefore, clinical follow-up was continued and no secondary surgery was performed. No complications occurred in all these 11 patients. The operation of treating unruptured intracranial wide-neck bifurcation aneurysms with WEB device alone is simple, and there is no need for anticoagulation and antiplatelet treatment before and after the operation, the clinical effect is being good. WEB device provides a new treatment option for intracranial wide-neck bifurcation aneurysms.

摘要

探讨编织型血管内桥接装置(WEB)治疗宽颈分叉动脉瘤的临床效果。回顾性分析2017年9月至2018年5月北部战区总医院神经外科收治的11例单纯采用WEB治疗的颅内宽颈分叉动脉瘤患者的临床及影像学资料。患者男7例,女4例,年龄(54±11)岁(31~66岁)。5例动脉瘤位于前交通动脉,3例位于基底动脉顶端,3例位于大脑中动脉分叉处。记录患者术中及术后情况,采用WEB栓塞动脉瘤闭塞分级量表(WOS)评估动脉瘤栓塞程度。11例患者术中WEB释放均顺利,WOS分级:A级3例,B级1例,C级7例,术中无急性并发症发生。1例患者因经济原因未行影像学随访,临床随访至术后3年情况良好;10例患者行影像学随访6个月至3年,靶治疗区无术后并发症发生。术中WOS分级A级的2例患者及B级的1例患者,术后随访均为A级;术中WOS分级C级的7例患者,随访4例仍为C级,3例为D级。WOS分级D级的3例患者中,1例因复发形态不佳、血流动力学不稳定、动脉瘤破裂可能性大而行二次栓塞,采用支架辅助弹簧圈栓塞,即刻效果良好;另2例复发动脉瘤形态良好、血流动力学稳定,继续临床随访,未行二次手术。11例患者均无并发症发生。单纯采用WEB装置治疗未破裂颅内宽颈分叉动脉瘤手术操作简单,术后无需抗凝及抗血小板治疗,临床效果良好。WEB装置为颅内宽颈分叉动脉瘤提供了一种新的治疗选择。

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