Sato Shinji, Kokubo Yasuaki, Kawanami Kanako, Itagaki Hiroshi, Matsumoto Yasushi, Sonoda Yukihiko
Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan.
Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Miyagi, Japan.
J Neuroendovasc Ther. 2022;16(5):250-256. doi: 10.5797/jnet.cr.2021-0065. Epub 2021 Sep 11.
We report a case in which coil embolization using crossing Y-configuration stenting was effective for an internal carotid-posterior communicating artery (IC-PC) aneurysm with repeated recurrence after clipping.
The patient was a 57-year-old woman. Nine months after undergoing clipping for a ruptured right IC-PC aneurysm at 55 years of age, she developed a second subarachnoid hemorrhage (SAH) due to recurrence of the aneurysm and underwent clipping at the same site. A third SAH due to rupture of the left IC-PC aneurysm developed 1.5 years after the second clipping. Simultaneously, recurrence of a right IC-PC aneurysm was noted and she was referred to our department. The recurrent right IC-PC aneurysm was considered to have originated from the distal to the initial neck. It was 7 mm in size and had an irregularly shaped wide neck. As it was assumed that there would be marked adhesion due to repeated surgery, we decided to treat the aneurysm by coil embolization instead of direct surgery. Although the aneurysm neck partially involved the posterior communicating artery (Pcom), tight packing with a minimal residual neck was required. Therefore, crossing Y-configuration stenting was deployed on the internal carotid artery and Pcom using two Neuroform Atlas stents, and coil embolization was performed by the jail technique. The recurrent aneurysm was obliterated. There were no deficits or thrombotic complications after surgery. On DSA follow-up, no compaction or recurrence was observed, and the Pcom was well visualized one year later.
Coil embolization by crossing Y-configuration stenting is a viable treatment option for a recurrent IC-PC wide neck aneurysm.
我们报告一例采用交叉Y形支架置入术进行弹簧圈栓塞治疗颈内动脉-后交通动脉（IC-PC）动脉瘤夹闭术后反复复发的病例。
患者为一名57岁女性。55岁时因右侧IC-PC动脉瘤破裂行夹闭术，9个月后因动脉瘤复发出现第二次蛛网膜下腔出血（SAH），并在同一部位再次行夹闭术。第二次夹闭术后1.5年，因左侧IC-PC动脉瘤破裂出现第三次SAH。同时，发现右侧IC-PC动脉瘤复发，遂转诊至我科。复发性右侧IC-PC动脉瘤被认为起源于初始瘤颈的远端。其大小为7mm，瘤颈宽且形状不规则。由于考虑到反复手术会导致明显粘连，我们决定采用弹簧圈栓塞而非直接手术治疗该动脉瘤。尽管动脉瘤颈部分累及后交通动脉（Pcom），但仍需要紧密填塞以使残留瘤颈最小化。因此，使用两枚Neuroform Atlas支架在颈内动脉和Pcom上部署交叉Y形支架，并采用“jail技术”进行弹簧圈栓塞。复发性动脉瘤被完全闭塞。术后无神经功能缺损或血栓形成并发症。DSA随访显示，术后一年未见弹簧圈压缩或复发，Pcom显影良好。
交叉Y形支架置入术进行弹簧圈栓塞是复发性IC-PC宽颈动脉瘤的一种可行治疗选择。
