Neuroform Atlas支架辅助弹簧圈栓塞术在未破裂宽颈颅内动脉瘤治疗中的临床应用
[Clinical application of Neuroform Atlas stent-assisted coiling in the treatment of unruptured wide-neck intracranial aneurysms].
作者信息
Han J T, Zhang Y X, Jia Z C, Jiang C H, Liu L, Luan J Y, Liang F, Zhao Y Q
机构信息
Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
出版信息
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Feb 18;55(1):139-143. doi: 10.19723/j.issn.1671-167X.2023.01.021.
OBJECTIVE
To assess the safety and efficacy of Neuroform Atlas stent used in treatment of unruptured wide-neck intracranial aneurysms.
METHODS
Clinical data of 62 patients with unruptured wide-neck intracranial aneurysms undergoing Neuroform Atlas stent-assisted coiling from August 2020 to September 2021 were retrospectively analyzed. There were 64 aneurysms in those 62 patients. Among them, 25 aneurysms were located at the bifurcation of M1 segment on middle cerebral artery, 16 at the anterior communicating artery, 10 at the C7 segment of internal carotid artery, 5 at the C6 segment of internal carotid artery, 4 at the apex of basilar artery, 3 at the A3 segment of anterior cerebral artery, and 1 at the M2 segment of middle cerebral artery. All the patients underwent Neuroform Atlas stent-assisted coiling, including 49 patients with single stent assisted coiling and 15 patients with dual stents assisted coiling (14"Y"style and 1"X"style). After the procedure, the immediate DSA was performed to evaluate the status of aneurysm occlusion and the parent artery patency. The clinical follow-up was performed 3 months after the operation and evaluated based on the modified Rankin Scale(mRS).DSA image was reviewed at 6 months after operation and Raymond grading scale was used to assess the status of aneurysm occlusion and the parent artery patency.
RESULTS
A total of 62 patients with 64 aneurysms were all achieved technical success(100%).The immediate post-procedural Raymond scale was assessed, including Raymond Ⅰ in 57 aneurysms(89.1%, 57/64), Raymond Ⅱ in 6 aneurysms(9.3%, 6/64) and Raymond Ⅲ in 1 aneurysm(1.6%, 1/64). The peri-procedural complications rate was 4.8%(3/62), 2 patients developed intraoperative thrombosis and 1 patient suffered from local subarachnoid hemorrhage. Among them, 55 patients obtained 3 months clinical follow-up after operation and all the patients had good outcomes (mRS≤2), 50 patients with 52 aneurysms were followed up with DSA 6 months after operation, including Raymond Ⅰ in 45 aneurysms(86.5%, 45/52), Raymond Ⅱ in 4 aneurysms(7.7%, 4/52) and Raymond Ⅲ in 3 aneurysms(5.8%, 3/52).
CONCLUSION
Neuroform Atlas stent for the treatment of unruptured wide-neck intracranial aneurysms has high safety and good efficacy, and has its advantages over other traditional stents.
目的
评估Neuroform Atlas支架治疗未破裂宽颈颅内动脉瘤的安全性和有效性。
方法
回顾性分析2020年8月至2021年9月期间62例接受Neuroform Atlas支架辅助弹簧圈栓塞治疗的未破裂宽颈颅内动脉瘤患者的临床资料。这62例患者共有64个动脉瘤。其中，25个动脉瘤位于大脑中动脉M1段分叉处，16个位于前交通动脉，10个位于颈内动脉C7段，5个位于颈内动脉C6段，4个位于基底动脉顶端，3个位于大脑前动脉A3段，1个位于大脑中动脉M2段。所有患者均接受Neuroform Atlas支架辅助弹簧圈栓塞治疗，其中49例为单支架辅助弹簧圈栓塞，15例为双支架辅助弹簧圈栓塞（14例“Y”型和1例“X”型）。术后即刻行数字减影血管造影（DSA）评估动脉瘤栓塞情况及载瘤动脉通畅情况。术后3个月进行临床随访，采用改良Rankin量表（mRS）进行评估。术后6个月复查DSA图像，采用Raymond分级量表评估动脉瘤栓塞情况及载瘤动脉通畅情况。
结果
62例患者64个动脉瘤均获得技术成功（100%）。术后即刻采用Raymond分级评估，其中57个动脉瘤为Raymond Ⅰ级（89.1%，57/64），6个动脉瘤为Raymond Ⅱ级（9.3%，6/64），1个动脉瘤为Raymond Ⅲ级（1.6%，1/64）。围手术期并发症发生率为4.8%（3/62），2例患者术中发生血栓形成，1例患者发生局部蛛网膜下腔出血。其中，55例患者术后获得3个月临床随访，所有患者预后良好（mRS≤2）；50例患者52个动脉瘤术后6个月行DSA随访，其中45个动脉瘤为Raymond Ⅰ级（86.5%，45/52），4个动脉瘤为Raymond Ⅱ级（7.7%，4/52），3个动脉瘤为Raymond Ⅲ级（5.8%，3/52）。
结论
Neuroform Atlas支架治疗未破裂宽颈颅内动脉瘤具有较高的安全性和良好的有效性，较其他传统支架具有优势。
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