Nakajo Takato, Terada Tomoaki, Tsumoto Tomoyuki, Matsuda Yoshikazu, Matsumoto Hiroaki, Nakayama Sadayoshi, Mizutani Tohru
Department of Neurosurgery, Kashiwa Tanaka Hospital, Kashiwa, Chiba, Japan.
Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan.
J Neuroendovasc Ther. 2023;17(10):209-216. doi: 10.5797/jnet.oa.2023-0028. Epub 2023 Aug 10.
In the acute stage of ruptured cerebral aneurysms, limited devices are available, making the treatment difficult. We aimed to evaluate the outcomes of the coil embolization with stenting for the ruptured cerebral aneurysms in the acute stage.
We assessed 22 cases treated with stenting among 134 of 169 consecutive patients with subarachnoid hemorrhages undergoing an endovascular treatment between April 2014 and December 2021, of which 134 underwent an embolization during the acute stage. A stent was used in the patients wherein the treatment with the balloon-assisted or double catheter technique was difficult. Stenting was performed under the loading of two or more antiplatelet agents.
The mean age of the patients was 68.9 years, of which five were male and 14 (63.6%) had severe grade (World Federation of Neurosurgeons grade IV, V). The aneurysm site was the anterior communicating artery in four cases, internal carotid artery in nine, middle cerebral artery in two, vertebrobasilar artery in six, and posterior cerebral artery in one. The aneurysm shape was saccular in 13 cases, dissection in seven, and fusiform in two. Stents were used for wide-neck aneurysms in 12 cases, vascular preservation in seven, and rescue in three. The mean maximum diameter was 9.6 mm. The mean neck size was 6.4 mm. Complete occlusion and neck remnant were found in eight and seven cases, respectively. The perioperative complication rate was 45.5% (thromboembolism in five cases, stent occlusion in two, re-bleeding in two, and cerebral hemorrhage in one). The outcomes included modified Rankin Scale 0-2 in seven cases, 4-5 in five, and 6 in nine. Stent-related death occurred in one case. The rate of morbidity and mortality was 18.2%. Although stents were used in the acute stage of rupture, they were used for the right reasons. However, a high rate of complications occurred: two cases of re-bleeding, in which an incomplete occlusion was a factor.
Stent placement in patients with the acute ruptured cerebral aneurysms should be carefully determined and efforts should be made to reduce the embolic and hemorrhagic complications. However, it may be an effective treatment option when other options could be extremely difficult.
在破裂脑动脉瘤的急性期，可用的设备有限，使得治疗困难。我们旨在评估急性期破裂脑动脉瘤的支架辅助弹簧圈栓塞治疗的效果。
我们评估了2014年4月至2021年12月期间169例接受血管内治疗的连续蛛网膜下腔出血患者中的134例，其中22例接受了支架置入治疗，134例在急性期进行了栓塞。在球囊辅助或双导管技术治疗困难的患者中使用了支架。在使用两种或更多种抗血小板药物的情况下进行支架置入。
患者的平均年龄为68.9岁，其中男性5例，14例（63.6%）为重度（世界神经外科医师联合会分级IV、V级）。动脉瘤部位：前交通动脉4例，颈内动脉9例，大脑中动脉2例，椎基底动脉6例，大脑后动脉1例。动脉瘤形态：囊状13例，夹层7例，梭形2例。12例宽颈动脉瘤、7例血管保留和3例补救性治疗使用了支架。平均最大直径为9.6mm。平均颈部大小为6.4mm。分别在8例和7例中发现完全闭塞和颈部残留。围手术期并发症发生率为45.5%（血栓栓塞5例，支架闭塞2例，再出血2例，脑出血1例）。结果包括改良Rankin量表0 - 2级7例，4 - 5级5例，6级9例。1例发生与支架相关的死亡。发病率和死亡率为18.2%。虽然在破裂急性期使用了支架，但使用理由合理。然而，并发症发生率较高：2例再出血，其中不完全闭塞是一个因素。
对于急性破裂脑动脉瘤患者，应谨慎决定是否放置支架，并应努力减少栓塞和出血并发症。然而，当其他选择极其困难时，它可能是一种有效的治疗选择。
