Tang Kai, Zhang Chao, Liu Xiaosong, Zhao Lei, Wang Xiaoliang, Liu Xiaomeng, Ma Shuangju, Gao Chao, Gao Shang, Zhang Gengshen, Hu Yuhua, Wu Jianliang
Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
Outpatient Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
Asian J Surg. 2023 Sep;46(9):3663-3672. doi: 10.1016/j.asjsur.2023.03.134. Epub 2023 Apr 1.
Aneurysms occurring in the ophthalmic segment (C6) of the internal carotid artery (ICA) have complex anatomy. This poses a challenge for the use of traditional open surgery, which is gradually being replaced by endovascular treatment (EVT). However, multiple aneurysm (MA) EVT, especially in MAs occurring ipsilaterally, has not been specifically described or discussed. The present study aimed to propose a more concise clinical classification standard for ipsilateral C6 ICA MAs and report on the clinical experience with EVT.
The cases of 18 patients with ipsilateral C6 ICA MAs treated with EVT were retrospectively reviewed. The treatment results and procedure-related complications were recorded, and clinical and angiographic follow-ups were performed at least six months after surgery.
A total of 38 ipsilateral C6 ICA aneurysms were treated during the study period and classified into four main types and six total subtypes based on anatomical features. There was a failure to coil through the stent in one aneurysm, while the remaining 37 were successfully treated using various EVT methods. Of these, 36 were completely concluded. One aneurysm had a size reduction, and one had no changes during the angiographic follow-up. All Tubridge flow diverter stents were patent. All patients achieved satisfactory clinical outcomes and were independent at the final follow-up.
EVT may be safe and feasible for the treatment of C6 ICA MAs. Traditional stent-assisted coiling methods, the Willis covered stent, and the double-layered low-profile visualized intraluminal support stent all achieved favorable results. The flow diverter stent is also considered a safe and efficient option for selected aneurysms, but the visual deficit risk should be considered. The present study introduces a new EVT classification option based on the anatomical features of an aneurysm.
颈内动脉（ICA）眼段（C6）动脉瘤解剖结构复杂。这给传统开放手术的应用带来了挑战，传统开放手术正逐渐被血管内治疗（EVT）所取代。然而，多发动脉瘤（MA）的EVT，尤其是同侧发生的MA，尚未有专门描述或讨论。本研究旨在提出一种更简洁的同侧C6段ICA多发动脉瘤临床分类标准，并报告EVT的临床经验。
回顾性分析18例接受EVT治疗的同侧C6段ICA多发动脉瘤患者的病例。记录治疗结果和与手术相关的并发症，并在术后至少6个月进行临床和血管造影随访。
研究期间共治疗38个同侧C6段ICA动脉瘤，根据解剖特征分为4种主要类型和6种总亚型。1个动脉瘤未能通过支架进行弹簧圈栓塞，其余37个采用各种EVT方法成功治疗。其中，36个完全栓塞。1个动脉瘤在血管造影随访期间体积缩小，1个未变化。所有Tubridge血流导向支架均通畅。所有患者均取得满意的临床结果，在最后一次随访时均能独立生活。
EVT治疗C6段ICA多发动脉瘤可能是安全可行的。传统的支架辅助弹簧圈栓塞方法、Willis覆膜支架和双层低轮廓可视化腔内支撑支架均取得了良好效果。血流导向支架对于选定的动脉瘤也被认为是一种安全有效的选择，但应考虑视觉缺损风险。本研究基于动脉瘤的解剖特征引入了一种新的EVT分类方法。
